Lupus érythémateux systémique induit par l’isoniazide: une complication rare à craindre

Jguirim, M.; Jbeli, Amna; Brahim, H. Ben; Mhenni, A.; Youssef, M. Ben; Touzi, M.; Zrour, S.; Béjia, I.; Bergaoui, N.

doi:10.11604/pamj.2015.20.181.5470

Cited by 4 publications

(2 citation statements)

References 8 publications

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“…A literature review suggested that isoniazid was the culprit drug among those used to treat the present patient [5,13]. The clinical presentation and ANA profile for this case are also similar to those reported by Jguirim et al for a previous case of isoniazid-induced SLE [14]. A pharmacovigilance investigation suggested a probable causal relationship between this drug and the reaction in the present case.…”

Section: Discussionsupporting

confidence: 83%

Isoniazid-Induced Systemic Lupus Erythematosus: A Case Report

Vaghela

Solanki

Lakhani

et al. 2019

Drug Saf - Case Rep

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Systemic lupus erythematosus (SLE) can be induced by various medications, such as hydralazine, procainamide, isoniazid, methyldopa, chlorpromazine, quinidine, and minocycline. A patient was admitted complaining of fever with chills and rigor. After being diagnosed with tuberculous meningitis, the patient was given antituberculosis treatment. As the patient did not improve, detailed investigations were conducted, and elevated antinuclear antibody levels were found. The consulting physician diagnosed that the patient was suffering from SLE. As isoniazid is associated with an increased risk of developing SLE, it was suspected as the culprit drug. After withdrawing isoniazid from the antituberculosis treatment regimen, the patient improved and was discharged. Based on the WHO-UMC and Naranjo's causality assessment criteria, an association between the reaction and isoniazid was deemed probable. The reaction was moderately severe (level 4b) according to the modified Hartwig and Siegel scale.

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Section: Discussionsupporting

confidence: 83%

Isoniazid-Induced Systemic Lupus Erythematosus: A Case Report

Vaghela

Solanki

Lakhani

et al. 2019

Drug Saf - Case Rep

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“…Jguirim et al reported two cases of isoniazid-induced lupus in young women; after three months of treatment to lymph node tuberculosis, one of them presented with polyarthralgia, a pruritic maculopapular rash in the photo-exposed regions and diffuse bald patches in the scalp; the other one presented with tenosynovitis in the right hand and arthritis in the left ankle after one month of exposure to isoniazid. Both had leukopenia and anemia [7].…”

Section: Discussionmentioning

confidence: 99%

Isoniazid-induced Lupus: When the Cure Can be Lethal

Cerqueira

Seco

Paiva

et al. 2020

Cureus

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A 50-year-old female with a past medical history of bone tuberculosis diagnosed nine months ago was admitted in our infirmary for persistent fever with no evident cause. The patient was treated with isoniazid, rifampicin, pyrazinamide, and ethambutol for seven months and for the past two months, she was taking isoniazid and rifampicin. She went to our emergency room (ER) for back pain and fever that she had been experiencing for the last month. She was admitted with suspicion of disseminated tuberculosis that was never confirmed. Physical examination was unremarkable. Blood tests showed an elevation of inflammation parameters. A computed tomography (CT) scan of the chest showed a mild pleural effusion. She remained with fever during the three weeks in the infirmary while undergoing many other studies that were all negative. The back pain would change sides, and three consecutive thoracic radiographies showed a small-sized pleural effusion that was either predominantly right-sided or left-sided. Several differential diagnoses were considered in the process, namely an active infection, neoplasia, or autoimmune disease. The search for circulating lupus anticoagulant was positive. Antinuclear antibodies (ANA) were positive and the anti-histone antibody was strongly positive. At this point, we suspected a drug-induced lupus diagnosis, and isoniazid was discontinued. Following discontinuation of isoniazid, back pain and fever subsided and patient was discharged after one week. This case is a diagnostic challenge because of the rarity and symptom severity of isoniazid-induced lupus. Isoniazid rarely induced this lupus-like syndrome, with an incidence of considerably less than 1%.

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Isoniazid

2016

Reactions Weekly

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S Isoniazid Systemic lupus erythematosus: 2 case reportsTwo patients developed systemic lupus erythematosus (SLE) while receiving isoniazid.A 35-year-old woman received isoniazid [dosage and route not stated] with rifampicin, pyrazinamide and ethambutol for 2 months, for lymph node tuberculosis. Following this, she received isoniazid and rifampicin. After 3 months of treatment, she presented with polyarthralgia, a pruriginous maculopapular rash on sun-exposed areas of skin and patches of alopecia on her scalp. Blood tests revealed leucopenia and anaemia. Immunological investigations showed presence of speckled-pattern antinuclear antibodies and positive results for anti-histone antibodies. She was diagnosed with isoniazidinduced lupus. Isoniazid was discontinued, and she was subsequently treated with ethambutol, rifampicin and pyrazinamide, as well as oral prednisolone and antimalarials for 6 months. One month after discontinuing isoniazid, her symptoms had completely regressed. After 6 months, her levels of antinuclear antibodies and anti-histone antibodies were negative.A 30-year-old woman was receiving isoniazid [dosage and route not stated], pyrazinamide, rifampicin and streptomycin for lymph node tuberculosis. After 1 month of treatment, she presented with tenosynovitis affecting the third finger of her right hand, and arthritis in her left ankle. Blood tests showed leucopenia, anaemia and biological inflammatory syndrome. Homogeneous pattern ANA was positive and positive native anti-DNA antibodies were measured at a significant level. Isoniazid was discontinued and she received oral prednisolone, nonsteroidal anti-inflammatories and antimalarials. She showed satisfactory clinical and biological progress after 3 months; immunological analysis was negative after 8 months.Author comment: We report here on two cases of isoniazid-induced lupus. Jguirim M, et al. Systemic lupus erythematosus induced by isoniazid: a rare complication to fear. Pan African Medical Journal 20: 181, Jan 2015 [French; summarised from an English translation] -Tunisia

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Lupus érythémateux systémique induit par l’isoniazide: une complication rare à craindre

Cited by 4 publications

References 8 publications

Isoniazid-Induced Systemic Lupus Erythematosus: A Case Report

Isoniazid-Induced Systemic Lupus Erythematosus: A Case Report

Isoniazid-induced Lupus: When the Cure Can be Lethal

Isoniazid

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