The first report of two cases of fatal liver injury due to anti-tuberculosis drugs in the presence of alpha-1 antitrypsin deficiency

Abstract

Tuberculosis (TB) is a major global health problem. Awareness of liver injury due to anti-TB therapy is vital because fulminant hepatic failure is a devastating and often fatal condition without liver transplantation. Here, we report for the first time, two patients of fatal liver injury due to anti-TB drugs in the presence of alpha-1 antitrypsin deficiency. Based on the triad of rapid loss in hepatocyte function, the onset of hepatic encephalopathy, and absence of a prior history of liver disease, the diagnosis of acute liver failure was established. Both patients had low levels of serum alpha-1 antitrypsin, consistent with alpha-1 antitrypsin deficiency. Despite aggressive medical therapy and supportive care, patients developed multi-organ failure and died. It seems measuring the serum levels of alpha 1-antitrypsin before beginning anti-TB therapies is necessary, especially when there is emphysema or bronchiectasis.

Increased Prevalence of Alpha-1-Antitrypsin Deficiency in Patients with Biliary Tract Cancer and Its Associated Clinicopathological Features

“…Of note, how patients with BTC and A1ATD respond to approved therapies and whether they exhibit a specific mutational profile remain largely unexplored [ 15 ]. As A1ATD might affect hepatocyte homoeostasis, liver function and its regenerative response, such knowledge might be valuable when managing patients with hepatotoxic medications or intended curative surgery involving extended resections [ 16 , 17 , 18 , 19 , 20 ]. Finally, an increased peripheral level of AAT was reported to be associated with metastasis and poor prognosis in various cancers, including hepatocellular carcinoma, and thus might have a potential interest in pre-operative settings in BTC [ 21 , 22 , 23 ].…”

Prognostic Value of Cyp3a4*1b Polymorphism in Patients With Pulmonary Tuberculosis

“…It is known that multi-drug resistant strains of M. tuberculosis more often belong to the Beijing family and lead to worse tuberculosis (TB) treatment outcome; infection with Beijing strains of M. tuberculosis can be considered as one of the unfavorable disease course factors [3; 4]. Adverse effects of anti-TB agents, which include anti-TB drug-induced liver injury observed in 10%-26% of TB patients who had standard short-course chemotherapy, are the important obstacles for successful TB treatment [5]. The risk of anti-TB drug-induced liver injury could be determined by patients' genotype polymorphism of the xenobiotic-metabolizing enzymes such…”