Ethambutol and isoniazid induced severe neurotoxicity in a patient undergoing continuous ambulatory peritoneal dialysis

Abstract

Ethambutol (EMB) and isoniazid (INH) are the first-line antituberculosis (anti-TB) drugs. However, their neurotoxicity could cause adverse effect and the patients with end-stage renal disease are especially vulnerable due to the reduction in renal drug clearance. Here, we report a 36-year-old man receiving peritoneal dialysis developed progressive paralysis in lower extremities, vision loss and hoarseness 4 months after anti-TB treatment with INH, EMB and rifapentine because of concomitant pulmonary tuberculosis. A diagnosis of EMB/INH-induced peripheral neuropathy, retrobulbar neuritis and laryngoparalysis was made. The patient's neuropathy gradually improved 2 years after discontinuation of EMB/INH. Since EMB and INH may cause simultaneously severe and complex multineuropathy in dialysis patients, their adverse effects should be closely supervised in dialysis patients.

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

“…180 With the need for prolonged treatment, PD patients should be monitored for side effects such as retrobulbar neuritis related to ethambutol and isoniazid-induced neuropathy characterised by paresthesia and burning symptoms of extremities. 381 Ethambutol should be omitted or suspended if or when M. tuberculosis is known to be fully susceptible to other agents.…”

Traduction française de «Recommandations de l’ ISPD sur la péritonite : Mise à jour 2022 de la prévention et du traitement. »

“…(y compris l'amlodipine et le métoprolol) [180]. En cas de nécessité d'un traitement prolongé, les patients de DP doivent être surveillés pour des effets secondaires tels que la névrite rétrobulbaire liée à l'éthambutol et la neuropathie induite par l'isoniazide caractérisée par une paresthésie et des symptômes de brûlure des extrémités [381]. L'éthambutol doit être omis ou suspendu si ou quand M. tuberculosis est connu pour être entièrement sensible à d'autres agents.…”

Unraveling the mechanisms of intrinsic drug resistance in Mycobacterium tuberculosis

“…Even with 6 months of chemotherapy, 5-10% of patients may experience disease relapse ( Lambert et al., 2003 ; Merle et al., 2014 ; Colangeli et al., 2018 ). The difficulty of treating TB can be attributed to a multitude of factors including variable drug penetration into infected lesions ( Dartois, 2014 ; Lenaerts et al., 2015 ) and treatment lapses due to toxic drug side effects ( Tostmann et al., 2008 ; Seddon et al., 2012 ; Si et al., 2018 ; Conradie et al., 2020 ). However, a major contributor to the difficulty of treating TB is the problem of bacterial drug resistance, which can broadly be classified into two main categories: intrinsic drug resistance and acquired drug resistance ( Walker et al., 2015 ; Xu et al., 2017 ; Batt et al., 2020 ).…”