Hepatotoxicity of antituberculosis drugs in a mother and a child affected by pulmonary tuberculosis - A case report

Cilj: Prikazati rezultate praćenja hepatotoksičnosti antituberkulotika u majke i djeteta primljenih na bolničko liječenje zbog tuberkuloze pluća. Ispitanici i metode: Majka (23 godine) i dijete (2 godine i 4 mjeseca) liječeni su izonijazidom, rifampicinom, pirazinamidom, etambutolom, odnosno streptomicinom. U svrhu praćenja hepatotoksičnosti antituberkulotika određivana je katalitička aktivnost aspartat-aminotransferaze (AST), alanin-ami-notransferaze (ALT), alkalne fosfataze (ALP), gamaglutamiltrasferaze (GGT), laktat-dehidrogenaze (LD) i bilirubina. Rezultati: U majke je najveće povećanje enzimskih aktivnosti postojalo 2. tjedna od primjene terapije: aktivnost AST bila je 34 puta, ALT 43 puta, ALP 1,2 puta, GGT 5,5 puta i LD 1,7 puta veća od gornjih referentnih granica. U djeteta je najveće povećanje enzimskih aktivnosti bilo 1. tjedna od primjene terapije: povećanje AST bilo je 28,1 puta, ALT 29,2 puta, GGT 2,5 puta i LD 3,3 puta od gornjih referentnih granica prema dobi. Nakon privremenog prekida terapije katalitička aktivnost enzima vratila se unutar referentnih granica, a terapija je postupno ponovno uvedena do pune doze. U daljnjem tijeku do izlječenja i majka i dijete dobro podnose terapiju antituberkuloticima bez povećanja enzimskih aktivnosti. Zaključak: Izrazito povećane katalitičke aktivnosti AST i ALT u majke i djeteta tijekom liječenja antituberkuloticima ukazuju na moguću predispoziciju za pojavu teškog stupnja hepatotoksičnosti. U prvim tjednima primjene antituberkulotika aktivnost jetrenih enzima potrebno je pratiti svakih tjedan dana kako bi se otkrila njihova moguća hepatotoksičnost te terapija pravodobno evaluirala.Aim: To present results of monitoring hepatotoxicity of antituberculosis drugs in a mother and a child admitted for hospital treatment due to pulmonary tuberculosis. Patients and methods: A mother (23 yrs) and a child (2 yrs and 4 months) were on isoniazid, rifampicin, pyrazinamide, ethambutol and streptomycin therapy. To monitor the hepatotoxicity of these antituberculosis drugs, catalytic activities of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma glutamyltransferase (GGT), lactate dehydrogenase (LD) and bilirubin were determined. Results: The highest increase in enzyme activity in the mother was recorded two weeks since the institution of therapy: AST, ALT, ALP, GGT and LD activities were 34-fold, 43-fold, 1.2-fold, 5.5-fold and 1.7-fold higher, respectively, than the upper normal values. In the child, the highest rise in enzyme activity occurred during the 1st week since the application of therapy; compared to the upper reference range values, AST, ALT, GGT and LD were 28.1-, 29.2-, 2.5-and 3.3-fold higher, respectively. After temporary discontinuation of therapy, the catalytic activity levels returned within the reference range limits, and the therapy was gradually reintroduced until full dose was achieved. During the subsequent period until recovery, both the mother and the child tolerated the antituberculosis drug therapy well, i.e. without elevation of enzyme activity. Conclusion: Markedly elevated catalytic activities of AST and ALT in the mother and the child during antituberculosis drug therapy indicate the occurrence of a possible predisposition for severe hepatotoxicity. During initial weeks of antituberculosis drug administration, it is necessary to monitor the activity of liver enzymes every week in order to detect their possible hepatotoxicity and carry out prompt therapy evaluation