HomeAnswersPulmonology (Asthma Doctors)pleural effusionAfter TB treatment, my daughter developed hepatitis. What to do?

When TB treatment was given, my daughter developed hepatitis. Why?

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Published At December 31, 2016
Reviewed AtJuly 3, 2023

Patient's Query

Hi doctor,

My daughter, who was a medical college student, was suffering from high fever and the doctor ordered an x-ray and it turned out to be a pleural effusion. Cytology was negative, so was the polymerase chain reaction (PCR) for tuberculosis (TB), the fluid was straw colored lymphocytes rich 90% with some neutrophil and mesothelial cells. The adenosine deaminase deficiency (ADA) was 40. My daughter has been on clinical rounds at college. TB was diagnosed and treatment initiated. Her fever went away. After five days of Isoniazid (INH), Rifampin (RIF), Ethambutol (ET) and Pyrazinamide (PZ), she developed hepatitis. She complained of severe nausea and vomiting and was admitted subsequently, and all tests for hepatitis A, B and C and antinuclear antibody (ANA) were negative. She was discharged when the liver function test (LFT) returned to normal. Her doctor started INH and RIF and 3 days later she started having the same issues of severe nausea and vomiting. She was put on ET, Levofloxacin and Clarithromycin (allergic to Streptomycin). She went for a chest x-ray a couple of weeks later (two months since tapping) and found the effusion has not completely subsided, though it did subside a little bit since when it was last observed (a month earlier). The doctor is starting INH (third time) now. I am worried about the recurrence of hepatitis. I would like to get some advice.

Hi,

Welcome to icliniq.com. We are here to help you. Yes, INH (Isoniazid) and Rifampicin are the actual culprits for the development of hepatitis. The best way is to reintroduce INH in a very small dose and gradually increasing it to the original dose with the monitoring of liver function tests. So, we need to do this in a planned way. Most people are able to tolerate smaller doses. I hope it will help your doctor.

Patient's Query

Thank you doctor,

Also, she has put on weight since restarting Ethambutol (ET), Levofloxacin and Clarithromycin. Does the effusion take time to clear out totally? She has not been able to complete even a week of Isoniazid (INH) and Rifampicin (RIF). Will introduction of INH and possibly an extended run help is clearing out the effusion? Also, do you think she got TB through her clinical postings? What can she or her friends or young medicos do to avoid picking up diseases in future? Her effusion has shown a small reduction since a month. She only took INH and RIF for five days in that month. The effusion is very mild at the moment. It was moderate and unilateral (right lung) prior to tapping.

Hi,

Welcome back to icliniq.com. Yes, pleural effusion takes time to get clear off, especially in people whom regimen has been changed due to hepatitis or any other complication of ATT (anti-tubercular drugs). Yes, this regimen by adding INH would help in clearing her effusion. It is difficult to say whether she got TB from clinical posting or not. But, it is likely as doctors are always at risk. She should eat more and morefruits and green leafy vegetables to boost up immunityin order to prevent any further hospital acquired infections.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Anshul Varshney
Dr. Anshul Varshney

Internal Medicine

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