EC Gastroenterology and Digestive System

Introduction: Antibacillary treatment is likely to cause a number of side effects among which toxic hepatitis. The latter can range from a simple transient disturbance of the liver balance to fulminant hepatitis.

Aim of the Study: The aim of our work is to highlight the frequency of hepatotoxicity of anti-bacillary drugs, the severity of certain lesions and the need for a rigorous follow-up for early detection and immediate discontinuation of treatment.

Methodology: This is a retrospective study from January 2012 to August 2021. During this period, 10 cases of patients followed for tuberculosis regardless of its location, hospitalized in our department, for management of acute hepatitis secondary to antituberculosis drugs.

Results: The mean age of our patients was 38 years, with a sex ratio M/F 0.66. The location of the tuberculosis was pulmonary in 4 cases, lymph node in 2 cases, peritoneal in 2 cases, pleural in 1 case and mammary in 1 case. The discovery of hepatotoxicity was made in 10 cases at the onset of clinical manifestations. All our patients were under anti-tuberculosis treatment combining rifampicin, isoniazid, pyrazinamide and ethambutol. There was no associated drug use. All patients had a correct initial liver function test but without a surveillance liver test during the course of the antituberculosis treatment. After an average of 60 days, the patients presented a frank cutaneous-mucosal jaundice followed by signs of hepatic encephalopathy up to coma in 1 case. The hepatic work-up showed a cytolytic hepatitis with a cytolysis superior to 10 times the normal. The mean value of prothrombin level was 44% [13 - 94%]. The etiological workup for a cause other than drugs was negative. The anti-tuberculosis treatment was stopped in all patients. The evolution was favorable in 8 patients with clinico-biological improvement. On the other hand, one patient presented a relapse in the form of a non severe acute hepatitis after progressive reintroduction of the antituberculosis treatment and one patient died at day 5 of his hospitalization.

Conclusion: Antibacillary toxic hepatitis can compromise the patient's vital prognosis hence the need for rigorous monitoring to detect and manage possible side effects as early as possible.

Keywords: Antibacillary Drugs; Hepatotoxicity of Variable Severity; Cytolytic Hepatitis; Treatment Discontinuation

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