Case Report: Pulmonary tuberculosis and raised transaminases without pre-existing liver disease- Do we need to modify the antitubercular therapy?

Abstract

We report a case of an adult female with pulmonary tuberculosis who had biochemical evidence of liver injury during the presentation manifested as raised transaminases, but without clinically obvious pre-existing liver disease nor a history of hepatotoxic drug use. This is a fairly common scenario seen in tuberculosis endemic areas; however, this is an under reported condition in the literature and guidelines for its management has not been established. Many clinicians including the authors have treated such cases with modified liver friendly regimens in fear of increasing the hepatotoxicity with standard antitubercular drugs. However, the modified regimens may not be optimal in treating the underlying tuberculosis. In this report, we gave full dose standard drugs, and the liver injury resolved as evidenced by normalization of transaminases. Further research is required in this regard, but the presence of transaminitis with no obvious common underlying etiology may not warrant a modification of standard antitubercular regimen.

Case Report: Using basic liver function tests as a guide to suspected Wilson’s disease

“…Nepal is a low-income country in South Asia, and a full chronic liver disease screening (including tests for Wilson’s disease, autoimmune hepatitis, hemochromatosis) is usually not possible in the Nepali health setup. The limited screen includes alcohol history, history of any drug or toxin use and serologies for hepatitis B and C. 2 However, the people mostly consume home-made alcohol in Nepal, and the exact quantification is usually not possible to estimate whether the amount of intake is significant enough to cause liver disease or not. 3 We usually ascribe liver disease in any patient to the alcohol, no matter the amount of intake by the patient, especially if serologies are nonreactive and there is no drug or toxin exposure.…”

Case Report: Using basic liver function tests as a guide to suspected Wilson’s disease

“…Nepal is a low-income country in South Asia, and a full chronic liver disease screening (including tests for Wilson's disease, autoimmune hepatitis, hemochromatosis) is usually not possible in the Nepali health setup. The limited screen includes alcohol history, history of any drug or toxin use and serologies for hepatitis B and C. 2 However, the people mostly consume home-made alcohol in Nepal, and the exact quantification is usually not possible to estimate whether the amount of intake is significant enough to cause liver disease or not. 3 We usually ascribe liver disease in any patient to the alcohol, no matter the amount of intake by the patient, especially if serologies are nonreactive and there is no drug or toxin exposure.…”