title: [A clinical investigation of seven patients with pulmonary tuberculosis who developed mixed liver injury during oral anti-tuberculosis treatment].
abstract: BACKGROUND
  Liver injury is the most common and clinically significant adverse reaction to anti-tuberculosis drugs, sometimes resulting in a fatal outcome. It has been reported that liver injury induced by isoniazid and pyrazinamide, which has the potential to cause hepatocellular injury, has a risk of becoming severe; while an injury induced by rifampicin, which has the potential to cause cholestatic injury, rarely becomes severe. However, mixed liver injury has not been studied thoroughly.
  
  
  METHODS
  Of 321 tuberculosis patients who were admitted and treated in our hospital over the past 5 years, 7 patients (2.1 %) who developed mixed liver injury due to the use of antituberculosis drugs were clinically investigated through their medical records.
  
  
  RESULTS
  There were 4 male patients and 3 female patients, with a mean age of 66.7 (59-85) years. The mean duration from the start of oral anti-tuberculosis drugs to the onset of mixed liver injury was 28.5 days. In 2 of the patients, the event occurred within 2 weeks. Two of them had a total bilirubin level of > 5 mg/dl at the time of diagnosis. In 6 of the 7 patients, the liver injury improved on discontinuation of the anti-tuberculosis drugs. In the remaining 1 patient, the liver injury progressed even after discontinuation of the oral treatment, leading to death.
  
  
  CONCLUSIONS
  Since mixed liver injury sometimes results in a fatal outcome, it is necessary to take adequate precautions.
authors.affiliation: Misato Central General Hospital, 745 Koubou, Misato-shi, Saitama 341-8526, Japan. fnoumi@gmail.com
authors.forename: Fumiko
authors.initials: F
authors.lastname: Nomi
authors.forename: Kiminori
authors.initials: K
authors.lastname: Hosaka
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kurosawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007538:Isoniazid / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011718:Pyrazinamide / Q000009:adverse effects; D012293:Rifampin / Q000009:adverse effects; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*
chemical_list: D000995:Antitubercular Agents; D011718:Pyrazinamide; D007538:Isoniazid; D012293:Rifampin