title: Is liver transplantation advisable for isoniazid fulminant hepatitis in active extrapulmonary tuberculosis?
abstract: Antituberculous treatment is a well-known cause of fulminant hepatic failure (FHF). This could lead to liver transplantation as the only possible treatment, which on the other hand could be contraindicated due to active tuberculosis. The risk of aggressive dissemination of the disease after transplantation is not clearly determined by the current second-line antituberculous therapies. We report a case of vertebral tuberculosis treated with rifampin, isoniazid and pyrazinamide. He developed an FHF that was treated with urgent liver transplantation. Despite the immunosuppression, the disease was well controlled with ciprofloxacin, ethambutol and streptomycin and the patient is in good health 23 months after transplantation. In conclusion, active extrapulmonary tuberculosis should perhaps be considered for liver transplantation when FHF develops due to anti-tuberculous drugs.
authors.affiliation: Hepato-Gastroenterology Service, Ramon y Cajal Hospital, Madrid, Spain. rbarcena.hrc@salud.madrid.org
authors.forename: Rafael
authors.initials: R
authors.lastname: Barcena
authors.forename: Elena
authors.initials: E
authors.lastname: Oton
authors.forename: Maria
authors.initials: M
authors.lastname: Angeles Moreno
authors.forename: Jesús
authors.initials: J
authors.lastname: Fortún
authors.forename: Miguel
authors.initials: M
authors.lastname: Garcia-Gonzalez
authors.forename: Ana
authors.initials: A
authors.lastname: Moreno
authors.forename: Emilio
authors.initials: E
authors.lastname: de Vicente
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007538:Isoniazid / Q000009:adverse effects* / Q000627:therapeutic use; D017114:Liver Failure, Acute / Q000139:chemically induced* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D014376:Tuberculosis / Q000188:drug therapy*
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid