A Severe Autoimmune-like Anti-Tuberculosis Drug-induced Liver Injury: Case Report and Review

Abstract

Drug-induced liver injury is one of the most significant adverse drugs reactions and, in severe cases, could be a potentially life-threatening condition. It can be classified in intrinsic and idiosyncratic reactions and, anti-tuberculous drugs are known to induce the later one. In some cases, it might develop some autoimmune features which represent a challenge for both diagnosis and treatment. We report a 37-year-old woman who was admitted to our hospital with signs of severe acute liver injury. She was diagnosed with autoimmune-like drug-induced liver injury by antituberculous drugs and was treated with corticosteroids, N-Acetylcysteine and Ursodesoxycholic acid. Indeed, based on this case a review of the literature is presented.

Acute Severe Autoimmune Hepatitis: Corticosteroids or Liver Transplantation?

“…Although the mechanisms are not fully elucidated, antituberculous medications can induce hypersensitivity reactions, leading to B cell–mediated autoantibody production and cytotoxic T cell responses that resemble spontaneous idiopathic AIH. There are case reports in both pediatric and adult patients, where corticosteroids have been used to treat antituberculous therapy–induced DILI . In such cases, if there are significant overlapping immune features, it may be worth trialing a course of corticosteroids if drug withdrawal alone is not adequate.…”

“…There are case reports in both pediatric and adult patients, where corticosteroids have been used to treat antituberculous therapy-induced DILI. (32)(33)(34) In such cases, if there are significant overlapping immune features, it may be worth trialing a course of corticosteroids if drug withdrawal alone is not adequate. This decision needs to be made in conjunction with the infectious diseases team in a multidisciplinary setting.…”