WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

Rohit Bangwal*, Jagdish Rawat, Dev Singh Jangpani

ABSTRACT

Anti-tubercular therapy (ATT) induced hepatitis is a major problem which a physician encounters in his clinical practice. A case of 28-year old female, weighing 45 kg was brought to hospital with the chief complains of high grade fever for the past two months, cough with expectoration, shortness of breath and 4-5 kg weight loss in two months. Her Chest X-ray showed right sided bilateral pulmonary TB and sputum acid fast bacilli (AFB) smear was repeatedly positive. Pulmonologist has started Category-I anti-tubercular regimen (Rifampicin, Isoniazid, Pyrazinamide and Ethambutol) under DOTS as per RNTCP guidelines. After 7 days of starting the treatment (DOTS regimen), she noticed yellowish discoloration of sclera, orange discoloration of urine but in spite of this she continued the drug for a further two weeks. Patient was found to be developing hepatotoxicity with the findings of elevated total bilirubin (10.2 mg/dl), conjugated bilirubin (2.5 mg/dl) and unconjugated bilirubin (7.2 mg/dl). Viral markers for hepatitis including hepatitis B viruses (HBsAg), hepatitis C viruses (HCV), human immunodeficiency virus (HIV), were all are non-reactive. Pulmonologist made final diagnosis of anti-tubercular drugs (specially rifampicin) induced hyperbilirubinemias. Pulmonologist initially hold Rifampicin and Pyrazinamide, but started Isoniazid, Ethambutol, Ofloxacin, Pyridoxine along with liver enzyme. She showed gradual improvement as bilirubin after one-week had dropped down to 1.2 mg/dl. Patient continued her drugs and came for review after three months. She was advised to continue and complete the course of anti-tubercular drugs. We have reported this case because of its rarity in clinical practice. As a health care team member clinical pharmacist are need to be made aware of these potentially fatal adverse effects associated with anti-tubercular therapy via conduction of quality-based seminars, published medical literature, conferences, learning programs and health care camps.

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