Severe hepatotoxicity associated with rifampin-pyrazinamide preventative therapy requiring transplantation in an individual at low risk for hepatotoxicity.
We report a case of severe hepatotoxicity associated with rifampin-pyrazinamide preventative therapy that required liver transplantation in a closely monitored, human immunodeficiency virus-uninfected individual who had no risk for hepatotoxicity. Because hepatotoxicity associated with this treatment appears to be idiosyncratic, we recommend closer monitoring of liver enzyme levels than do the Centers for Disease Control and Prevention guidelines, as well as at least temporary interruption of treatment during any elevation of liver enzyme levels greater than the normal value.
Kunimoto
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Division of Infectious Diseases, Department of Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada, T6G 2B7. Dennis.Kunimoto@ualberta.ca
Warman
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A
Beckon
A
A
Doering
D
D
Melenka
L
L
D000328:Adult; D000904:Antibiotics, Antitubercular / Q000009:adverse effects* / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002487:Centers for Disease Control and Prevention, U.S.; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D016377:Organ Transplantation; D011718:Pyrazinamide / Q000009:adverse effects* / Q000627:therapeutic use; D012293:Rifampin / Q000009:adverse effects* / Q000627:therapeutic use; D012306:Risk; D014376:Tuberculosis / Q000188:drug therapy / Q000517:prevention & control; D014481:United States
D000904:Antibiotics, Antitubercular; D000995:Antitubercular Agents; D011718:Pyrazinamide; D012293:Rifampin