A Woman with Tuberculosis Multidrug Resistance and QTc Prolongation Repetitive Interval: A Case Report

Kusmiati, Tutik; Mertaniasih, Ni Made; Putranto, Johanes Nugroho Eko; Suprapti, Budi; Soedarsono, -; Bahmid, Abdul Rahman

doi:10.37506/ijfmt.v15i4.17119

Indian Journal of Forensic Medicine & Toxicology

2021

DOI: 10.37506/ijfmt.v15i4.17119

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A Woman with Tuberculosis Multidrug Resistance and QTc Prolongation Repetitive Interval: A Case Report

Tutik Kusmiati¹,

Ni Made Mertaniasih²,

Johanes Nugroho Eko Putranto³

et al.

Abstract: Background : Prolonged QTc interval is one of the side effects of the short-regimen MDR-TB. QTc prolongation is a risk factor for Torsades de pointes and is influenced by many factors. Case : 47-year-old woman who was diagnosed with MDR-TB through GeneXpert examination and received short-regimen MDR-TB. This patient experienced repeated QTc prolongation, with peak QTc interval 600 msec occurring at 4th month with mild hypokalemia without clinical symptoms. The patient completed 9 months of shortregimen therapy… Show more

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Cited by 2 publications

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Antituberculars

2021

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Treatment failure and QTc interval prolongation: case reportA 47-year-old woman exhibited treatment failure during treatment with rifampicin and unspecified antitubercular drugs for pulmonary tuberculosis (TB). Additionally, she developed QTc interval prolongation during treatment with clofazimine and moxifloxacin for multidrug-resistant (MDR) pulmonary TB [not all routes, dosages and duration of treatments to reactions onsets stated].The woman, who had pulmonary TB, was treated with catgory 1 oral antitubercular therapy consisting of rifampicin and unspecified antitubercular drugs. However, this therapy failed to treat her pulmonary TB. GeneXpert examination showed rifampicin-resistant pulmonary TB. A confirmed diagnosis of MDR pulmonary TB was considered and she started receiving shortterm MDR-TB therapy with moxifloxacin 600mg, clofazimine 100 mg/day, kanamycin [kanamicin], ethionamide [ethionamid], isoniazid, pyrazinamide and ethambutol. However, after 1 week of therapy, she experienced prolonged QTc interval of 545 msec.The woman's moxifloxacin therapy was discontinued for 3 days. Following discontinuation of moxifloxacin, her QTc interval returned to normal at 411 msec.The woman was again initiated on moxifloxacin at a dose of 400mg. After 1 week, her QTc interval was 468 msec. Moxifloxacin dose was increased to 600mg. At the second month from initiation of treatment, her QTc interval was 471 msec. She started receiving advanced stage of therapy. However, at the fourth month from initiation of treatment, she again developed a prolonged QTc interval of 600 msec. Hence, moxifloxacin was temporarily discontinued. Subsequent laboratory examination showed mild hypokalaemia [aetiology not stated]. As a corrective measures, she received potassium therapy. After correction of hypokalaemia, the QTc interval returned to normal (443 msec). Moxifloxacin therapy was again started at a dose of 200mg for 7 days which was then increased to 400mg dose. At the fifth month of therapy, her QTc interval was 491 msec. However, at the seventh month of therapy, she again experienced a prolonged QTc interval of 539 msec. Moxifloxacin was continued. Clofazimine dose was decreased to 50 mg/day. After a week of evaluation, the QTc interval returned to normal (433 msec), and clofazimine dose was again increased to 100 mg/day until the end of treatment. She completed short-term MDR-TB therapy. Her TB was declared to have been resolved after completion of therapy. The QTc interval prolongation was considered to be secondary to clofazimine and moxifloxacin therapy.

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Antituberculars

2021

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Grade III Severe QT Prolongation in an Indian Male on All-Oral Longer Regimen for Multidrug-Resistant Pulmonary Tuberculosis: World’s First Case

Yadav¹

2022

Cureus

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Antitubercular drugs are associated with several adverse drug reactions (ADRs). Some of these ADRs are lifethreatening and require immediate attention and hospital admission. With the development of new regimens and inclusions of newer drugs such as bedaquiline, pretomanid, and delamanid, it is imperative to have an eye for the side effects. A number of antitubercular drugs such as bedaquiline, moxifloxacin, clofazimine, pretomanid, and delamanid are known to cause ADRs on the heart. Herein, a case of grade III severe QT prolongation with corrected QT (QTc) of 688 ms in an Indian male on a WHO-recommended alloral longer regimen (AOLR) for multidrug-resistant (MDR) pulmonary tuberculosis (TB) is presented. This episode happened on the sixth day post his treatment initiation, thereby making it the earliest of such findings. The patient was managed conservatively, and his baseline electrocardiogram (ECG) returned to normal with QTc of 432 ms with the offending drug as moxifloxacin, which was omitted from the regimen and replaced with delamanid. There are some cases similar to this case available in the literature; however, grade III severe QT prolongation with QTc of 688 ms in a male on a WHO-recommended all-oral longer regimen for multidrug-resistant pulmonary tuberculosis is never reported.

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A Woman with Tuberculosis Multidrug Resistance and QTc Prolongation Repetitive Interval: A Case Report

Cited by 2 publications

References 8 publications

Antituberculars

Antituberculars

Grade III Severe QT Prolongation in an Indian Male on All-Oral Longer Regimen for Multidrug-Resistant Pulmonary Tuberculosis: World’s First Case

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