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Fatal and Severe Hepatitis Associated With Rifampin and Pyrazinamide
for the Treatment of Latent Tuberculosis Infection --- New York and
Georgia, 2000
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"Fatal and Severe Hepatitis Associated With Rifampin and Pyrazinamide
for the Treatment of Latent Tuberculosis Infection --- New York and
Georgia, 2000
One of the recommended treatments for latent tuberculosis infection (LTBI) is a
9-month regimen of isoniazid (INH); a 2-month regimen of rifampin (RIF)
and pyrazinamide (PZA) is an alternative in some instances. In September 2000, a man
in New York died of hepatitis after 5 weeks of RIF-PZA, and in December, a woman
in Georgia was admitted to a hospital because of hepatitis after 7 weeks of this
regimen. This report summarizes the findings of the investigations of these incidents,
which underscore the need for clinical monitoring for adverse effects in all patients
receiving treatment for LTBI.
Case 1
A 53-year-old incarcerated man received 600 mg (6.7 mg/Kg) RIF and 1750 mg
(19 mg/Kg) PZA daily after screening revealed a tuberculin skin test (TST) with 20
mm induration and no radiologic or clinical findings of active tuberculosis (TB). His
risk factors for TB included previous work as a medical orderly, homelessness,
and multiple incarcerations. He had a history of hypertensive heart disease and
alcoholism without evidence of chronic liver disease. He was not known to inject drugs.
RIF-PZA was standard treatment for LTBI at the jail. Baseline and 1-month
serum aminotransferase and bilirubin levels were measured routinely. The patient's
baseline aminotransferase levels were slightly higher than the upper-normal limits. He
was instructed to stop taking RIF-PZA if he developed symptoms suggestive of hepatitis.
He also received 325 mg enteric-coated aspirin daily, 90"
....
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