Serious adverse drug reactions in a case of neurotuberculosis

Abstract

Introduction: Tuberculosis remains one of the most important infectious disease plaguing the developed and developing countries worldwide. Antitubercular drugs (ATD) are associated with a wide spectrum of adverse drug reactions (ADR), which often pose a significant problem. Vigilant ADR monitoring and close follow up is needed to ensure early detection and prompt management of such untoward events and minimize the morbidity associated with them. Case summary: We report a case of ATD induced hepatitis with bilateral optic neuritis along with corticosteroid induced proximal myopathy in a young male patient of 21 years with neurotuberculosis. Although ATD induced hepatitis and ethambutol induced optic neuritis are established clinical entities but the infrequent occurrence of such diverse ADRs in the same patient encouraged us to report it. A Medline search till December 2006 revealed that there are no such reported cases. Each suspected adverse reaction was assessed for causality using the Naranjo's ADR probability scale and it was found to be of definite association of INH induced hepatotoxicity and probable association of ethambutol induced optic neuritis and corticosteroid induced proximal myopathy. Conclusion: This case is being reported taking into consideration the rarity of simultaneous occurrence of a plethora of adverse drug reactions in the same patient and also to highlight the problem that clinicians face while treating patients of tuberculosis due to the occurrence of such ADRs.