Pyrazinamide
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Thrombocytopenia: case report A 20-year-old man developed thrombocytopenia during treatment with pyrazinamide [time to reaction onset not stated]. The man started receiving oral pyrazinamide 1500 mg/day, streptomycin, rifampicin, isoniazid and ethambutol. After 14 days of therapy, he was referred for tubercular meningitis with a 1-month history of fever, headache and decreased appetite, and a 4-day history of a generalised purpuric rash. Rifampicin-induced thrombocytopenia was suspected. Examination showed multiple, discrete, erythematous lesions over his entire body. Laboratory investigations revealed the following: haemoglobin 8g%, WBC count 8800/mm3, platelet count 40 000/mm3, bleeding time 7min and clotting time 13min. A Mantoux test was strong positive. The man was conservatively managed. His skin eruption subsided, and his platelet count improved to 4.5 lac/mm3 after 12 days. On day 13, antitubercular therapy was resumed with streptomycin and isoniazid; ethambutol was added on the third day. His platelet count remained normal. On day 17, the man was rechallenged with pyrazinamide 500mg once daily, and his platelet count decreased to 80 000/mm3. Pyrazinamide was again stopped, while other antituberculars were continued. Rifampicin was restarted on day 19, and his platelet count remained normal. His bleeding profile had remained normal after 2 months of therapy. Author comment: "[P]yrazinamide was probably the casual [sic] drug for thrombocytopenia (Naranjo scale: 6)." Kant S, et al. Pyrazinamide induced thrombocytopenia. Indian Journal of Pharmacology 42: 108-109, No. 2, Mar 2010. Available from: URL: http:// 803032381 dx.doi.org/10.4103/0253-7613.64495 - India
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Reactions 14 Aug 2010 No. 1314
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