A CLINICAL INVESTIGATION OF SEVEN PATIENTS WITH PULMONARY TUBERCULOSIS WHO DEVELOPED MIXED LIVER INJURY DURING ORAL ANTI-TUBERCULOSIS TREATMENT

[Background] Liver injury is the most common and clinically significant adverse reaction to anti-tuberculosis drugs, sometimes resulting in a fatal outcome. It has been reported that liver injury induced by isoniazid and pyrazinamide, which has the potential to cause hepatocellular injury, has a risk of becoming severe; while an injury induced by rifampicin, which has the potential to cause cholestatic injury, rarely becomes severe. However, mixed liver injury has not been studied thoroughly. [Methods] Of 321 tuberculosis patients who were admitted and treated in our hospital over the past 5 years, 7 patients (2.1 ％) who developed mixed liver injury due to the use of antituberculosis drugs were clinically investigated through their medical records. [Results] There were 4 male patients and 3 female patients, with a mean age of 66.7 (59-85) years. The mean duration from the start of oral anti-tuberculosis drugs to the onset of mixed liver injury was 28.5 days. In 2 of the patients, the event occurred within 2 weeks. Two of them had a total bilirubin level of ＞5 mg/dl at the time of diagnosis. In 6 of the 7 patients, the liver injury improved on discontinuation of the anti-tuberculosis drugs. In the remaining 1 patient, the liver injury progressed even after discontinuation of the oral treatment, leading to death. [Conclusion] Since mixed liver injury sometimes results in a fatal outcome, it is necessary to take adequate precautions.