Isoniazid

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CNS toxicity in a child: case report A 12-year-old girl developed CNS toxicity while receiving isoniazid for tuberculosis (TB) prophylaxis. Three months after starting prophylactic isoniazid 10 mg/kg/day [route of administration not stated], the girl was referred to a paediatric neurology clinic complaining of dizziness and hand tremors. Neurological examination showed ataxia, dysdiadochokinesia, dysmetria, intentional tremor, and a positive Romberg test. Cranial MRI revealed bilateral and symmetrical increased signal intensity at both cerebellar dentate nuclei, and between the thalamus and mesencephalic areas on T2-weighted and FLAIR imaging. Diffusion-weighted restriction in the thalami and posterior limb of the internal capsula was demonstrated in diffusionweighted MRI images. Her blood isoniazid level was 16 µg/mL (normal < 3 µg/mL). On the assumption that the clinical and MRI findings were due to isoniazid toxicity, the drug was discontinued. About 1 month later, the girl’s clinical and MRI findings were completely resolved. Author comment: "Other diagnoses were excluded in the present case by microbiological investigations, imaging features, metabolic tests, a high blood [isoniazid] level, and the commencement of symptoms after [isoniazid] use and the fact that symptoms stopped rapidly after discontinuing treatment." Hasiloglu ZI, et al. MRI findings of isoniazid-induced central nervous system toxicity in a child. Clinical Radiology 67: 932-935, No. 9, Sep 2012. Available 803077442 from: URL: http://dx.doi.org/10.1016/j.crad.2012.01.015 - Turkey

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Reactions 29 Sep 2012 No. 1421