Exchange Transfusion as Treatment of Acute Hepatic Failure Due to Antituberculosis Drugs

Abstract

A 23-year-old female with miliary tuberculosis developed fulminant hepatic decompensation 1 month after beginning INH [isoniazid] and PAS [para-aminosalicylic acid] therapy; coma failed to respond to corti-costeroid therapy and routine measures for control of hepatic failure. After 8 and 12 unit exchange transfusions on successive days the patient regained consciousness and has subsequently returned to normal liver function. This is the 1st case of drug-related hepatic failure to respond to exchange therapy. INH and PAS are both incriminated as causes of the hepatic failure. The patient''s pruritus, generalized maculopapular eruption, eosinophilia and hepatitis are classic manifestations of PAS but may occur with INH. Steroid therapy has subsequently been required to control persisting skin rash while antituberculosis therapy with secondary agents is pursued. The possibility that drugs may have unmasked a lupus diathesis unlikely.