A CLINICAL CASE REPORT ON PREDICTABLE DRUG-INDUCED LIVER INJURY
Sri Latha L., Mounika D.*, Dr. Anjana Male, Dr. CH. Manoj Kumar and Jyothi Vamsi Krishna G.
ABSTRACT
Drug-induced hepatitis is one of the major drug-related problems which a general practitioner encounters in his clinical practice. Predictable Drug-Induced Liver Injury is generally characterized by certain dose-related injury in experimental animal models, has a higher attack rate, and tends to occur rapidly. Injurious free radicals cause hepatocyte necrosis in zones farthest from the hepatic arterioles, where metabolism is greatest and antioxidant detoxifying capacity is the least. Unpredictable or idiosyncratic reactions comprise most types of DILI. These hypersensitivity or metabolic reactions occur largely independent of dose and relatively rarely for each drug, and may result in hepatocellular injury and/or cholestasis. This is a case report focusing on a 46 years female patient who experienced hepatotoxicity after administration of antitubercular drugs, like Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol are the first-line agents in the treatment of Tuberculosis. The patient was receiving anti-tubercular drugs for 6 months and developed hepatitis, which is a severe adverse drug reaction of Antitubercular medications. Naranjo's causality assessment algorithm was used to assess the adverse effect and it indicated anti-tubercular drugs as a probable cause of hepatitis. Hepatotoxicity is typically distinctive or dose-dependent measurements of AST, bilirubin, and alkaline phosphates are adjunctive for monitoring severe hepatocellular injury. We have reported this clinical case because of its scarcity in clinical practice.
Keywords: Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol.
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