Barcena Rafael, Oton Elena, Angeles Moreno Maria, Fortún Jesús, Garcia-Gonzalez Miguel, Moreno Ana, de Vicente Emilio
Hepato-Gastroenterology Service, Ramon y Cajal Hospital, Madrid, Spain.
Am J Transplant. 2005 Nov;5(11):2796-8. doi: 10.1111/j.1600-6143.2005.01065.x.
Antituberculous treatment is a well-known cause of fulminant hepatic failure (FHF). This could lead to liver transplantation as the only possible treatment, which on the other hand could be contraindicated due to active tuberculosis. The risk of aggressive dissemination of the disease after transplantation is not clearly determined by the current second-line antituberculous therapies. We report a case of vertebral tuberculosis treated with rifampin, isoniazid and pyrazinamide. He developed an FHF that was treated with urgent liver transplantation. Despite the immunosuppression, the disease was well controlled with ciprofloxacin, ethambutol and streptomycin and the patient is in good health 23 months after transplantation. In conclusion, active extrapulmonary tuberculosis should perhaps be considered for liver transplantation when FHF develops due to anti-tuberculous drugs.
抗结核治疗是暴发性肝衰竭（FHF）的一个众所周知的病因。这可能导致肝移植成为唯一可行的治疗方法，但另一方面，由于存在活动性结核病，肝移植可能是禁忌的。目前的二线抗结核治疗方法并未明确确定移植后疾病侵袭性播散的风险。我们报告一例用利福平、异烟肼和吡嗪酰胺治疗的脊柱结核病例。他发生了FHF并接受了紧急肝移植治疗。尽管进行了免疫抑制，但疾病通过环丙沙星、乙胺丁醇和链霉素得到了良好控制，患者在移植后23个月健康状况良好。总之，当因抗结核药物导致FHF发生时，对于活动性肺外结核或许应考虑进行肝移植。
