Gopi Manigandan, Seshadri Mandalam Subramanian
Consultant Physician, Department of Internal Medicine, Thirumalai Mission Hospital , Ranipet, Tamilnadu, India .
Consultant Physician & Endocrinologist, Department of Internal Medicine, Honorary Medeical Director, Thirumalai Mission Hospital , Ranipet, Tamilnadu, India .
J Clin Diagn Res. 2016 Apr;10(4):OD14-5. doi: 10.7860/JCDR/2016/18040.7614. Epub 2016 Apr 1.
Drug induced hepatitis is a major problem which a physician encounters in his clinical practice. In view of increasing incidence of tuberculosis in our country a large number of infected individuals are started on Antituberculous (ATT) drugs and rifampicin is invariably part of the regimen. One of the major adverse effects of ATT drugs is drug- induced hepatitis which is characterized by elevation of liver enzymes and bilirubin. Hepatotoxicity is usually idiosyncratic or dose-dependent. Rifampicin causes transient elevation of transaminases in 10-20 percent of individuals and this does not warrant dose adjustments of the drug. Rarely rifampicin can lead to severe hepatitis with hyperbilirubinaemia and marked elevations of SGOT and SGPT and in some patients this can be fatal. The exact mechanism of Rifampicin induced hepatotoxicity is not known but it is postulated to be due to idiosyncratic reaction to rifampicin metabolites which may be directly toxic or induce an immunologically mediated liver injury. Rarely rifampicin may cause hyperbilirubinaemia without enzyme elevation. Here we report a patient with bilateral pulmonary tuberculosis who developed transient severe indirect hyperbilirubinaemia on rifampicin. On review of relevant literature we find that rifampicin can have a biphasic effect on bilirubin, an initial increase in indirect bilirubin and later normalization of bilirubin. We have reported this case because of its rarity in clinical practice.
药物性肝炎是医生在临床实践中遇到的一个主要问题。鉴于我国结核病发病率不断上升，大量感染者开始使用抗结核药物（ATT），而利福平始终是治疗方案的一部分。抗结核药物的主要不良反应之一是药物性肝炎，其特征是肝酶和胆红素升高。肝毒性通常是特异质性的或剂量依赖性的。利福平会使10%至20%的个体转氨酶短暂升高，这种情况无需调整药物剂量。利福平极少会导致严重肝炎，伴有高胆红素血症以及谷草转氨酶（SGOT）和谷丙转氨酶（SGPT）显著升高，在某些患者中这可能是致命的。利福平所致肝毒性的确切机制尚不清楚，但据推测是由于对利福平代谢产物的特异质性反应，这些代谢产物可能具有直接毒性或引发免疫介导的肝损伤。利福平极少会导致无酶升高的高胆红素血症。在此，我们报告一名双侧肺结核患者，在使用利福平后出现短暂性严重间接高胆红素血症。在查阅相关文献时，我们发现利福平对胆红素可能有双相作用，即最初间接胆红素升高，随后胆红素恢复正常。我们报告此病例是因为其在临床实践中较为罕见。
