Isoniazid
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Systemic lupus erythematosus: case report A 14-year-old girl developed systemic lupus erythematosus (SLE) during treatment with isoniazid for tuberculous meningitis. The girl, who was hospitalised, was started on treatment with ceftriaxone, dexamethasone, mannitol, ondansetron, ranitidine, sodium chloride [normal saline], and Ringer’s lactate solution. On hospital day 1, she was diagnosed with tuberculous meningitis based on a brain MRI, and she was prescribed anti-tuberculosis therapy. On hospital day 2, she continued to receive the same treatment along with of O positive erythrocytes [red cell concentrates] for low haemoglobin level. Based on the MRI scan report and the CSF report, which suggested tuberculous meningitis, she started receiving a category 2 regimen, which included isoniazid [route and dosage not stated], rifampicin, ethambutol, pyrazinamide and streptomycin, as per weight band. She had a history of an adverse reaction in the form of skin lesions on the head and both limbs due to unspecified anti-tuberculosis therapy. She continued to receive the same therapy on days 3 and 4. On hospital day 5, she complained of fever, muscle weakness, joint pain, common cold, convulsion with multiple skin lesions and multiple oral ulcers. The girl started receiving sodium valproate for the convulsions. Antinuclear antibody profile report was positive, which indicated SLE secondary to isoniazid. Subsequently, isoniazid was discontinued for 15 days, and she was treated with clotrimazole, fluconazole and unspecified multivitamins along with the previous treatment, which included unspecified corticosteroids. She improved after 15 days, and she was discharged with antituberculosis regimen without isoniazid. She had developed moderately severe (level 4b) SLE based on the modified Hartwig and Siegel scale of reaction severity. Author comment: "Here we present a case of isoniazidinduced systemic lupus erythematosus." "According to the WHO-UMC causality assessment criteria, an association between the reaction and the drug was probable. Naranjo’s score was 8 (probable)." Vaghela JH, et al. Isoniazid-Induced Systemic Lupus Erythematosus: A Case Report. Drug Safety - Case Reports 6: 1-3, No. 1, Part 7, Dec 2019. Available 803432951 from: URL: http://doi.org/10.1007/s40800-019-0102-y - India
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Editorial comment: Details of this case report have previously been published [see Reactions 1734 p299; 803366132].
0114-9954/19/1778-0001/$14.95 Adis © 2019 Springer Nature Switzerland AG. All rights reserved
Reactions 9 Nov 2019 No. 1778
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