TÜBERKÜLOZ TEDAVİSİ SIRASINDA GELİŞEN HEPATOTOKSISITE: OLGU SUNUMU

Öz

Tüberküloz dünyada ve gelişmekte olan ülkelerde önemli bir morbidite ve mortalite nedenidir. Son yıllarda olgularda artış görülmektedir. Tedavisinde en az 6 ay süreyle isoniazid, rifampisin, pirazinamid ve ethambutol gibi 1. basamak ilaçların kullanılması temeldir. Tedavide ilaç direnci önemli bir sorun oluşturduğu için çoklu ilaç tedavisi uygulanmaktadır. Tüberküloz tedavisinde kullanılan ilaçlar yan etki potansiyeline sahiptirler. En sık görülen yan etki hepatotoksisitedir. Bu durumda, ilaç tedavisine ara verilmesi ve karaciğer etkilenmesi geçtikten sonra tedaviye tekrar başlanması önerilmektedir. Burada deri tüberkülozu tanısı alan olgunun tedavisi sırasında gelişen hepatotoksisiteyi sunarak, anti tüberküloz tedavinin oluşturduğu hepatotoksisiteyi gözden geçirmeyi amaçladık.

Anahtar Kelimeler

• Anti-Tüberküloz ilaçlar
• deri tüberkülozu
• hepatotoksisite

THE HEPATOTOXOCITY DEVELOPPED DURING TUBERCULOSIS TREATMENT: A CASE REPORT

Öz

Tuberculosis is still a significant reason of the morbidite and mortality in the worldwide, especially in developing countries. The cases have been increasing in recent years. The usage of
first step drugs such as isoniazid, rifampisin, pirazinamid ve ethambutol is essential at least for a six month and drug resistance is an important handicap in the treatment. The multi-drug terapy is , therefore, usually prefered for the treatment of disease to avoid it. The drugs used tuberculosis do have some potential side effects and the most common one is hepatotoxicity at all. In this circumstance, a definite intervals should be given until eliminating of the toxic effects by laboratory studies and then, resumed the terapy. As we have presented in here a case
developped hepatotoxicity to revise the effects of the first step anti- tuberculosis drugs during the treatment of a case diagnosed as a cutaneous tuberculosis.

Anahtar Kelimeler

• Anti-tuberculosis drugs
• Cutaneous Tuberculosis
• Hepatotoxicity

Kaynakça

1. World Health Organization Global Tuberculosis Programme. Treatment of Tuberculosis:
2. Guidelines for National Programmes, 3rd edn. (WHO/CDS/TB/2003.13). Geneva: World
3. Health Organization 2003.
4. Singal A, Sonthalia S. Cutaneous tuberculosis in children: the Indian perspective. Indian
5. J Dermatol Venereol Leprol. 2010; 76: 494-503.
6. Frieden TR, Sterling TR, Munsiff SS, Watt CJ, Dye C. Tuberculosis. Lancet. 2003; 362:
7. -99.
8. Girling DJ. The hepatic toxicity of antituberculosis regimens containing isoniazid,

9. rifampicin and pyrazinamide. Tubercle 1978; 59: 13–32.
10. Ormerod LP. Hepatotoxicity of antituberculos drugs. Thorax. 1996; 51: 111-13.
11. WHO. International Monitoring of Adverse Reactions to Drugs:Adverse Reaction
12. Terminology. Uppsala: WHO Collaborating Center for International Drug Monitoring
13. -
14. American Thoracic Society, CDC, and Infectious Diseases Society of America. Treatment
15. of Tuberculosis. MMWR 2003; 52: /No.RR-11http://www.thoracic.org/
16. sections/publications/statements/ pages/mtpi/rr5211.html.
17. Task Force of ERS, WHO and the Europe Region of IUATLD. Tuberculosis management
18. in Europe.Eur Respir J. 1999; 14: 978-92.
19. Steel MA, Burk RF, Desperez RM. Toxic hepatitis with isoniazid and rifampin. Chest
20. ; 99: 467-71.
21. Dossing M, Wilcke JT, Askgaard DS, Nybo B. Liver injury during antituberculosis
22. treatment: an 11-year study. Tuber. Lung Dis. 1996; 77: 335–40.
23. Mitchell I, Wendon J, Fitt S, Williams R. Anti tuberculous therapy and acute liver failure.
24. Lancet 1995; 345: 555-6.
25. Pande JN, Singh SPN, Khilnani GC, et al. Risk factors for hepatotoxicity from
26. antituberculosis drugs: A case-control study. Thorax 1996; 51: 132.
27. Ceylan E.Bingöl Verem Savaş Dispanseri’nde Tüberküloz Tedavisine Bağlı Toksik
28. Hepatit Sıklığı. Toraks Dergisi 2005; 6: 132-6.
29. Çakan A, Erbaycu AE, Dereli Ş, Özsöz A. Tüberküloz Tedavisi Sırasında Gelişen
30. Hepatotoksisitede Klinik Yaklaşım. Tüberküloz ve Toraks Dergisi 2002; 50: 480-4.
31. Tost JR, Vidal R, Cayla J, Diaz-Cabanela D, Jimenez A, Broquetas JM. Severe
32. hepatotoxicity due to anti-tuberculosis drugs in Spain. Int. J. Tuberc. Lung Dis. 2005; 9:
33. –40.
34. Sharifzadeh M, Rasoulinejad M, Valipour F, Nouraie M, Vaziri S. Evaluation of patientrelated
35. factors associated with causality, preventability, predictability and severity of
36. hepatotoxicity during antituberculosis [correction of antituberclosis] treatment.
37. Pharmacol. Res. 2005; 51: 353–8.
38. Tostmann A Boeree MJ, Aarnoutse RE, de Lange WC, van der Ven AJ, Dekhuijzen R.
39. Antituberculosis drug-induced hepatotoxicity: concise up-to-date review. J Gastroenterol
40. Hepatol. 2008; 23: 192-202.
41. Schaberg T, Rebhan K, Lode H. Risk factors for side-effects of isoniazid, rifampin and
42. pyrazinamide in patients hospitalized for pulmonary tuberculosis. Eur. Respir. J. 1996; 9:
43. –30.
44. Mitchell JR, Thorgeirsson UP, Black M, Timbrell JA, Snodgrass WR, Potter WZ, Jollow
45. HR, Keiser HR. Increased incidence of isoniazid hepatitis in rapid acetylators: possible
46. relation to hydranize metabolites. Clin Pharmacol Ther. 1975; 18: 70-9.
47. Grosset J, Leventis S. Adverse effects of rifampin. Rev Infect Dis 983; 3: 440-50.
48. Pessayre D. Present vievvs on isoniazid and isoniazid-rifampicin hepatitis. Agressologie
49. ; 23(A): 13-15.
50. Wolinsky E. Tuberculosis. In Baum GL, Wolinsky E eds: Textbook of Pulmonary
51. Diseases. 5th ed, Boston, New York, Toronto, London, Little, Brovvn and Company,
52. ; 521-73.
53. Özkara Ş, Aktaş Z. Türkiye’de Tüberkülozun Kontrolü İçin Kılavuz. Ankara, 1999; 21-
54. -
55. Taşkın A, Çobanlı B, Ayas G. Tüberküloz tedavisi sırasında hepatotoksik reaksiyonlar.
56. Tüberküloz ve Toraks 1993; 41: 77-81.
57. Blumberg HM, Burman WJ, Chaisson RE et al. American Thoracic Society/Centers for
58. Disease Control and Prevention/Infectious A Tostmann et al. Anti-TB drug-induced
59. hepatotoxicity Diseases Society of America: treatment of tuberculosis. Am. J. Respir. Crit
60. Care Med. 2003; 167: 603–62.