Isoniazid-induced Immune Thrombocytopenia

Kuwabara, Gaku; Tazoe, Kumiyo; Imoto, Waki; Yamairi, Kazushi; Shibata, Wataru; Oshima, Kazuhiro; Yamada, Koichi; Takagi, Yasuhiro; Shiraishi, Satoshi; Hino, Masayuki; Kawaguchi, Tomoya; Kakeya, Hiroshi

doi:10.2169/internalmedicine.6520-20

Cited by 5 publications

(5 citation statements)

References 18 publications

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“…Kuwabara et al found that isoniazid also causes immune thrombocytopenia by complement activation [ 10 ]. The bronchial clot, in this case, was a consequence of the vocal cord bleed, as the blood was continuously aspirated into the bronchus and formed a clot.…”

Section: Discussionmentioning

confidence: 99%

“…This case illustrates how ATT can cause severe thrombocytopenia, which can lead to bleeding or bleeding tendencies. There are other side effects of ATT, which need timely monitoring, which include ethambutol-induced optic neuropathy, alteration in liver enzymes, chronic active hepatitis, acute hepatitis, acute kidney injury, aplastic anemia, and peripheral neuropathy [ 10 ]. This case highlights the importance of considering different causes of hemoptysis and hematemesis, and of conducting a comprehensive airway assessment in such patients.…”

Section: Discussionmentioning

confidence: 99%

“…Kuwabara et al found that isoniazid also causes immune thrombocytopenia by complement activation [10].…”

Section: Discussionmentioning

confidence: 99%

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Anti-Tubercular-Therapy-Induced Severe Thrombocytopenia Presenting as a Vocal Cord Bleed With Massive Hemoptysis Causing Mortality: A Catastrophic Combination

Shaikh,

Toshniwal,

Wanjari

et al. 2024

Cureus

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Severe thrombocytopenia induced by anti-tubercular therapy (ATT) is a rare but potentially life-threatening complication. Severe thrombocytopenia is a known adverse effect of ATT, but its association with fatal hemoptysis is rare. Hematemesis and hemoptysis are two serious symptoms that indicate bleeding from the upper gastrointestinal and the lower respiratory tract, respectively. We report a rare case of a 65-year-old man, a diagnosed case of tuberculosis on ATT, who presented with massive hemoptysis. On navigating the bleed, the source was found to be a vocal cord bleed, which further led to massive clot formation in the left bronchus, leading to the collapse of the subsequent lung, leading to mortality. This case emphasizes the importance of recognizing ATT as a potential cause of bleeding and considering causes of massive hematemesis that are not gastrointestinal. It also highlights the need for a thorough evaluation of the airway in such patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Anti-Tubercular-Therapy-Induced Severe Thrombocytopenia Presenting as a Vocal Cord Bleed With Massive Hemoptysis Causing Mortality: A Catastrophic Combination

Shaikh,

Toshniwal,

Wanjari

et al. 2024

Cureus

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“…În cazul dat la pacient s-a dezvoltat o trombocitopenie acută și severă, în pofida absenței expunerii anterioare la R. Au fost raportate cazuri de trombocitopenie severă precoce, după expunerea inițială cu un debut până la 4-14 zile, care pot fi determinat și de factorii genetici sau de mediu predispozanți. Numărul de trombocite revine în decurs de o săptămână după întreruperea expunerii la preparatul sensibilizant, iar cazurile severe pot fi necesare alte tratamente, inclusiv glucocorticizi și imunoglobuline intravenos [6,8].…”

Section: Rezultate Și Discuțiiunclassified

Adverse hematological and coagulability reactions to the use of antituberculosis preparations

Bacinschi,

Donica,

Tudor

2024

BulMed

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Treatment of tuberculosis requires long-term use of antituberculosis drugs with a high risk of side effects. In recent decades, along with the frequent and detailed side effects (gastrointestinal symptoms, hepatotoxicity, neurotoxicity, allergic reactions), hematological and coagulation disorders have been described when taking antituberculosis drugs. Their main manifestations can be: iron deficiency anemia, hemolytic anemia, megaloblastic and sideroblastic anemia, thrombocytopenia, thrombocytopenic purpura, leukopenia, eosinophilia, agranulocytosis, deep vein thrombosis, thromboembolism, disseminated intravenous coagulopathy, etc. Although these side effects are rare, they require special attention because they can appear more frequently in the case of intermittent or interrupted treatment and present diagnostic difficulties.

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“…Therefore, LZD was changed to intravenous TZD, an oxazolidinone similar to LZD but not known to cause thrombocytopenia [ 5 , 6 ]. In addition, intravenous administration of INH was also suggested as the cause of thrombocytopenia [ 7 ], and it was changed to intramuscular administration of SM 300 mg twice/week. The patient’s condition remained stable; his platelet count increased to 167×10 3 /µL, and serum C-reactive protein decreased to 1.41 mg/dL.…”

Section: Case Reportmentioning

confidence: 99%

A Mycobacterium tuberculosis-Infected Patient Who Could Not Tolerate Oral Intake Successfully Treated Using an Intravenous Tedizolid-Containing Regimen

et al. 2022

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Patient: Male, 77-year-old Final Diagnosis: Pulmonary tuberculosis Symptoms: Appetite loss Medication: — Clinical Procedure: — Specialty: Infectious Diseases Objective: Unusual or unexpected effect of treatment Background: Mycobacterium tuberculosis ( M. tuberculosis ) is usually treated by oral antimycobacterial agents, including rifampicin, ethambutol, and pyrazinamide, but the treatment regimen with intravenous and/or intramuscular antimycobacterial agents for patients who cannot take medications orally remains unclear. Case Report: A 77-year-old man with chronic renal failure had an esophageal-skin fistula after he had surgeries for removal of esophageal and gastric cancers and reconstruction using jejunum, and he showed a cavity, tree-in-bud formation, and pleural effusions in his left upper lung fields on his chest X-ray after treatment of cellulitis and bacteremia/candidemia by meropenem, teicoplanin, and micafungin. M. tuberculosis was isolated from his sputum and exudate fluid from the reconstructed esophageal-skin fistula. Although he could not take antimycobacterial agents orally, treatment was started with intravenous agents combining levofloxacin (LVFX) every other day, isoniazid (INH), and linezolid (LZD). However, his platelets were decreased 21 days after treatment started, and it was thought to be an adverse effect of LZD and/or INH. After changing LZD to tedizolid (TZD), in addition to changing from INH to intramuscular streptomycin twice per week, his platelet counts increased. Intravenous TZD could be continued, and it maintained his condition without exacerbations of thrombocytopenia and renal failure. The M. tuberculosis disappeared, and the abnormal chest X-ray shadows were improved 2 months after the start of treatment. Conclusions: Administration of intravenous TZD, in addition to intravenous LVFX and intramuscular SM in combination, might be a candidate regimen for M. tuberculosis patients who cannot take oral medications.

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Isoniazid-induced Immune Thrombocytopenia

Cited by 5 publications

References 18 publications

Anti-Tubercular-Therapy-Induced Severe Thrombocytopenia Presenting as a Vocal Cord Bleed With Massive Hemoptysis Causing Mortality: A Catastrophic Combination

Anti-Tubercular-Therapy-Induced Severe Thrombocytopenia Presenting as a Vocal Cord Bleed With Massive Hemoptysis Causing Mortality: A Catastrophic Combination

Adverse hematological and coagulability reactions to the use of antituberculosis preparations

A Mycobacterium tuberculosis-Infected Patient Who Could Not Tolerate Oral Intake Successfully Treated Using an Intravenous Tedizolid-Containing Regimen

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