title: Risk factors of acute hepatic failure during antituberculosis treatment: two cases and literature review.
abstract: Hepatotoxicity is a well-known side effect of antituberculosis treatment (ATT). If not recognised in time, drug-induced hepatitis can develop, which may rapidly progress to acute liver failure. We describe two patients with acute hepatic failure caused by ATT, whose pretreatment liver function had been normal. Both patients successfully underwent liver transplantation. Possible risk factors predisposing towards ATT-induced hepatic failure were evaluated, and at least four risk factors were present in these patients. Although available guidelines do not advocate routine monitoring of liver function during ATT unless baseline values are elevated or in the case of pre-existent liver disease, this is nevertheless common practice. Liver function should always be measured in patients who develop symptoms during ATT, and rising liver function parameters should prompt immediate action to prevent the occurrence of liver failure. This report underscores that regular monitoring of liver function parameters and adherence to guidelines is especially important in patients with risk factors for ATT-induced liver disease. An evaluation of chronic viral hepatitis in risk groups before starting ATT could be worthwhile.
authors.affiliation: Department of Infectious Diseases, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Smink
authors.forename: B
authors.initials: B
authors.lastname: van Hoek
authors.forename: J
authors.initials: J
authors.lastname: Ringers
authors.forename: R
authors.initials: R
authors.lastname: van Altena
authors.forename: S M
authors.initials: SM
authors.lastname: Arend
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000139:chemically induced* / Q000175:diagnosis; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D000995:Antitubercular Agents