A Case Report: Ethambutol Causes a Rare Adverse Effect of Peripheral Neuropathy

Abstract

Mycobacterium gordonae is a slow-growing acid-fast bacilli mycobacterium with low pathogenic potential. Patients with this infection are treated with antimycobacterial agents such as ethambutol, clarithromycin, and rifampin. We present a rare side effect of ethambutol causing peripheral neuropathy, along with regression of this upon discontinuation of the inciting medication. A 78-year-old male with a past medical history of lumbar degenerative disc disease and lumbosacral radiculopathy presented to the clinic with three weeks of progressively worsening rhinorrhea, nasal congestion, and productive cough with yellow sputum. After a bronchoalveolar lavage (BAL) and a chest computed tomography (CT) scan, he was diagnosed with an M. gordonae infection. He was started on a 12-month triple regimen of rifampin, clarithromycin, and highdose ethambutol. During the first three months of antibiotic therapy, the patient began to have symptoms of gastrointestinal upset and worsening numbness in bilateral lower extremities, especially at night. Because he was unable to tolerate these adverse effects, the patient stopped taking these medications three months into his 12-month course. Upon stopping the antimycobacterial therapy, the patient's neuropathy began to return to baseline. Based on imaging, electromyography (EMG), nerve conduction studies (NCS), and a literature search of antimycobacterial medicines, we concluded that the high dose of ethambutol is the most likely cause of this patient's peripheral neuropathy. An important takeaway is that while ethambutol is a well-known cause of optic neuritis, it may also lead to peripheral neuropathy, which may regress upon discontinuation of the medication.

Toxic neuropathies: a practical approach

“…Optic neuropathy (commonly associated with neuropathies due to nutritional deficiencies) and CNS manifestations may also occur. Ethambutol more commonly causes optic than peripheral neuropathy; however, there have been a few cases of axonal sensory neuropathy described, with improvement after stopping the drug 21…”

Letter: Acute Pancreatitis – A Rare Complication of Common Tropical Infections!

“…Apart from dengue fever, malaria and scrub typhus too may rarely be complicated by pancreatitis. 4 5 Prompt treatment of infection with appropriate drugs leads to good outcome in such cases. 4 5 Acute pancreatitis occurs in 3.7 to 5.65% of patients with acute viral hepatitis.…”

“…4 5 Prompt treatment of infection with appropriate drugs leads to good outcome in such cases. 4 5 Acute pancreatitis occurs in 3.7 to 5.65% of patients with acute viral hepatitis. It is usually mild and recovers with conservative management.…”

“…6 7 The mechanism of pancreatitis in such patients is multifactorial—secondary to development of edema of the ampulla of Vater, direct inflammation and destruction of pancreatic acinar cell by the virus, and release and circulation of lysosomal enzymes from the inflamed liver with the activation of trypsinogen to trypsin. 5 Few cases of acute pancreatitis caused by Salmonella infection have been reported. Presentations may range from mild abnormalities to pancreatic abscesses requiring surgical treatment.…”