Case Report: Management of a Severe Adverse Drug Reaction to First-Line Anti-Tuberculosis Therapy in a Port Harcourt Patient

Authors: Hart, C.A.,¹ & Oki, K.²

¹Department of Clinical Pharmacy, ²Department of Pulmonology, University of Port Harcourt Teaching Hospital.

Introduction: Drug-induced liver injury (DILI) is a known serious adverse effect of anti-tuberculosis (TB) therapy. We present a case of severe DILI managed successfully with a tailored drug rechallenge protocol.

Case Presentation: A 28-year-old female diagnosed with pulmonary TB developed jaundice, fever, and markedly elevated transaminases (ALT > 500 U/L) two weeks into first-line therapy (HRZE). All drugs were stopped immediately. After liver function normalized, a systematic rechallenge was initiated.

Management and Outcome: Isoniazid was identified as the causative agent. Therapy was restarted with rifampicin, ethambutol, and pyrazinamide, while isoniazid was replaced with levofloxacin. The patient completed the modified regimen successfully with no further hepatic events.

Conclusion: This case highlights the importance of clinical vigilance, prompt intervention, and the feasibility of supervised drug rechallenge to identify the culprit drug and ensure TB treatment completion, thus preventing resistance.

Keywords: Adverse Drug Reaction, Pharmacovigilance, Tuberculosis, Drug-Induced Liver Injury, Case Report.