Aminy Rusdi Zakki, Kholili Ulfa
Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
Ann Med Surg (Lond). 2022 Jul 12;80:104154. doi: 10.1016/j.amsu.2022.104154. eCollection 2022 Aug.
Pulmonary tuberculosis patients infected with hepatitis B are at high risk for drug-induced liver injury.
A 42-year-old Indonesian female complained of sclera icterus, tea-colored urine, vomiting, dyspnea, and swollen stomach and legs. The patient experienced this condition after taking anti-tuberculosis drugs for five days. Her medical history showed hepatitis B and cirrhosis. Follow-up examination included chest X-ray and GeneXpert supported a diagnosis of pulmonary tuberculosis. However, abdominal ultrasonography indicated ascites and cirrhosis. We diagnosed the patient with anti-tuberculosis DILI, cirrhosis Child-Pugh C (score 12) related to hepatitis B, and pulmonary tuberculosis. We decided to stop the anti-tuberculosis drug. We treated the patient using tenofovir, hepatoprotective drug, diuretics, and albumin infusion. On the third day, the patient received new anti-tuberculosis drugs, including levofloxacin 750 mg, ethambutol 1000 mg, and streptomycin 1000 mg (LES). The patient's condition then gradually improved.
The dilemma of treating tuberculosis in liver disease is treating tuberculosis without ignoring hepatitis B and cirrhosis.
Administration of anti-tuberculosis drugs based on liver tolerance of hepatotoxic drug in patients with hepatitis B and cirrhosis.
感染乙型肝炎的肺结核患者发生药物性肝损伤的风险很高。
一名42岁的印度尼西亚女性主诉巩膜黄染、茶色尿、呕吐、呼吸困难以及腹部和腿部肿胀。该患者在服用抗结核药物五天后出现了这种情况。她的病史显示患有乙型肝炎和肝硬化。后续检查包括胸部X光和GeneXpert检测，支持肺结核的诊断。然而，腹部超声检查显示有腹水和肝硬化。我们诊断该患者患有抗结核药物性肝损伤、与乙型肝炎相关的肝硬化Child-Pugh C级（评分12分）以及肺结核。我们决定停用抗结核药物。我们使用替诺福韦、保肝药物、利尿剂和白蛋白输注对患者进行治疗。第三天，患者开始使用新的抗结核药物，包括750毫克左氧氟沙星、1000毫克乙胺丁醇和1000毫克链霉素（LES）。患者的病情随后逐渐好转。
在肝病患者中治疗结核病的困境在于既要治疗结核病，又不能忽视乙型肝炎和肝硬化。
对于患有乙型肝炎和肝硬化的患者，应根据肝毒性药物的肝脏耐受性来使用抗结核药物。
