Isoniazid-Related Hepatitis

Abstract

Conclusive evidence of isoniazid (INH)-related hepatotoxicity ranging from asymptomatic elevation of liver enzymes to fulminant hepatic failure resulting in liver transplantation and/or death has been firmly established. Anticipation of the widespread usage of INH in the prevention and treatment of tuberculosis is expected due to the recent increasing incidence of tuberculosis. The aim of this article is to review the current concepts of pathogenesis, histopathology, risk factors and clinical features of INH-related hepatitis, emphasizing the need for vigilance.

A novel mechanism for drug-induced liver failure: Inhibition of histone acetylation by hydralazine derivatives

“…The characteristic features of fulminant hepatitis caused by todralazine were (1) late onset after administration, (2) prolonged jaundice despite rapid improvement of serum ALT that occurred after discontinuation of todralazine, (3) dose-dependent severities [1], which were similar to the present case. This pattern is also common in patients who have been exposed to other hydralazine derivatives [2][3][4][5]. These features can not be explained only by hepatotoxicity of the type previously reported [6].…”

Effect of Treatment of Latent Tuberculosis Infection on the T Cell Response toMycobacterium tuberculosisAntigens

“…First, it is known that the TST on which the decision to prescribe is based is flawed in both sensitivity and specificity [1,11]. Second, antituberculous drug therapy must be prescribed for prolonged periods to essentially healthy people, and there is an appreciable risk of drug toxicity [21,22]. Third, there is no way that the physician can tell whether the treatment has been effective.…”

Methotrexate combined with isoniazid treatment for latent tuberculosis is well tolerated in patients with rheumatoid arthritis: experience from an urban arthritis clinic

“…INH is used in combination with other antituberculosis treatment for active disease and in populations at high risk of exposure to drug-resistant strains. INH hepatotoxicity is a common complication that ranges in severity from asymptomatic elevation of LFT to hepatic failure requiring liver transplantation 8 9. Mild elevation of LFT (up to three times the ULN) is seen in as many as 10–33% of patients with INH with most patients asymptomatic; however, 10–16% of those with early mild elevations of LFT develop severe hepatitis that may progress to liver failure if the drug is not promptly discontinued.…”