A Severe Autoimmune-like Anti-Tuberculosis Drug-induced Liver Injury: Case Report and Review

Abstract

Drug-induced liver injury is one of the most significant adverse drugs reactions and, in severe cases, could be a potentially life-threatening condition. It can be classified in intrinsic and idiosyncratic reactions and, anti-tuberculous drugs are known to induce the later one. In some cases, it might develop some autoimmune features which represent a challenge for both diagnosis and treatment. We report a 37-year-old woman who was admitted to our hospital with signs of severe acute liver injury. She was diagnosed with autoimmune-like drug-induced liver injury by anti-tuberculous drugs and was treated with corticosteroids, N-Acetylcysteine and Ursodesoxycholic acid. Indeed, based on this case a review of the literature is presented. J Microbiol Infect Dis 2018; 8(3):128-134

Keywords

• Anti-tuberculous drugs; Corticosteroids; Drug-induced Liver Injury,N-Acetylcysteine,Tuberculosis

References

1. 1) Chalasani NP, Hayashi PH, Bonkovsky HI, Navarro VJ, Lee WM, Fontana RJ. ACG clinical guideline: The diagnosis and management of idiosyncratic drug-induced liver injury. The Am J Gastroenterol 2014; 109(7):950-966. 2) Ramappa V, Aithal GP. Hepatotoxicity related to anti-tuberculosis drugs: mechanisms and management. J Clin Exp Hepatol 2013;3(1): 37-49. 3) Naqvi IH, Mahmood K, Talib A, Mahmood A. Antituberculosis drug-induced liver injury: an ignored fact, assessment of frequency, patterns, severity and risk factors. Open Journal of Gastroenterology 2015;5(12):173-184. 4) Yu YC, Mao YM, Chen CW, et al. CSH guidelines for the diagnosis and treatment of drug-induced liver injury. Hepatol Int 2017; 11(3):221-241. 5) Saukkonen JJ, Cohn DL, Jasmer RM, et al. An Official ATS Statement: Hepatotoxicity of Antituberculosis Therapy. Am J Respir Crit Care Med 2006; 174(8):935-952. 6) Altındiş M, Çetinkaya Z, Kalaycı R, Ciftçi IH, Arslan A, Aktepe OC. Detection of Mycobacterium isolates with different methods and their resistance ratios against anti-tuberculosis drugs. J Microbiol Infect Dis 2011; 1 (1): 5-9. 7) Alarcón V, Alarcón E, Figueroa C, Mendoza-Ticona A. Tuberculosis en el Perú: situación epidemiológica, avances y desafíos para su control. Rev Peru Med Exp Salud Publica 2017; 34(2): 299-310. 8) Saithanyamurthi H, Faust AJ. Drug-Induced Liver Disease: Clinical Course. Clin Liver Dis 2017; 21(1):21-34. 9) Giordano C, Rivas J, Zervos X. An update on treatment of drug-induced liver injury. J Clin Transl Hepatol 2014;2(2):74-79. 10) Abbara A, Chitty S, Roe JK, et al. Drug-induced liver injury from antituberculous treatment: a retrospective study from a large TB centre in the UK. BMC Infect Dis 2017; 17(1):231. 11) Jong E, Conradie F, Berhanu R, et al. Consensus statement: Management of drug-induced liver injury in HIV-positive patients treated for TB. South Afr J HIV Med 2013; 14(3): 113-119. 12) Pozniak A, Bracchi M, Awosusi F, et al. British HIV Association guidelines for the management of TB/HIV co-infection in adults, 2017 [Internet]. Bhiva.org. 2018 [cited 1 May 2018]. Available from: http://www.bhiva.org/documents/Guidelines/TB/BHIVA-TB-HIV-co-infection-guidelines-consultation.pdf 13) Nahid P, Dorman SE, Alipanah N, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis. Clin Infect Dis 2016; 63(7):147-195. 14) deLemos AS, Foureau DM, Jacobs C, Ahrens W, Russo MW, Bonkovsky HL. Drug-induced liver injury with autoimmune features. Semin Liver Dis 2014; 34(2):194-204. 15) Rangel MA, Pinto I, Duarte R, Carvalho I. Antituberculosis Drug-Induced Liver Injury with Autoimmune Features: Facing Diagnostic and Treatment Challenges. Case Rep Pediatr 2017; 2017:5741896. 16) Stine JG, Lewis JH. Current and future directions in the treatment and prevention of drug-induced liver injury: a systematic review Expert Rev Gastroenterol Hepatol 2016; 10(4):517-536. 17) Lee WM, Hynan LS, Rossaro L, et al. Intravenous N-Acetylcysteine improves transplant free survival in early stage non-acetaminophen acute liver failure. Gastroenterology 2009; 137(3):856-64. 18) Nabi T, Nabi S, Rafiq N, Shah A. Role of N-acetylcysteine treatment in non-acetaminophen-induced acute liver failure: A prospective study. Saudi J Gastroenterol 2017; 23(3):169-175. 19) Darweesh SK, Ibrahim MF, El-Tahawy MA. Effect of N-acetylcysteine on mortality and liver transplantation rate in non-acetaminophen-induced acute liver failure: A multicenter study. Clin Drug Investig 2017; 37(5):473-482. 20) Hu J, Zhang Q, Ren X, Sun Z, Quan Q. Efficacy and safety of acetylcysteine in "non-acetaminophen" acute liver failure: A meta-analysis of prospective clinical trials. Clin Res Hepatol Gastroenterol 2015; 39(5):594-599. 21) Hu PF, Wang PQ, Chen H, et al. Beneficial effect of corticosteroids for patients with severe drug-induced liver injury. J Dig Dis 2016; 17(9):618-627. 22) Wree A, Dechêne A, Herzer K, et al. Steroid and ursodesoxycholic acid combination therapy in severe drug-induced liver injury. Digestion 2011; 84(1):54-59.