SHM Converge Scientific Abstract ePoster Gallery-A Case of Acute Liver Failure in a Patient on Inh Prophylaxis for Latent Tuberculosis

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This case report describes a 44-year-old woman with latent tuberculosis who developed acute liver failure after six months of isoniazid (INH) prophylaxis. She presented with two weeks of right-sided abdominal pain, anorexia, and jaundice. She had no alcohol use, illicit drug use, herbal supplement use, or known family history of liver disease.<br /><br />On admission, labs showed severe hepatocellular injury with markedly elevated bilirubin, AST, and ALT, along with worsening INR and rising MELD-Na score, indicating progressive liver dysfunction. Because of clinical deterioration and coagulopathy, she underwent a transjugular liver biopsy. The biopsy showed submassive necrosis, hepatocellular dropout, lobular inflammation, and bile ductular proliferation without fibrosis, consistent with acute drug-induced liver injury. These findings supported the diagnosis of INH-induced hepatotoxicity causing acute liver failure.<br /><br />Treatment included stopping the offending drug and providing supportive care with oral furosemide, ursodiol, and two courses of intravenous N-acetyl cysteine (NAC) for non-acetaminophen drug-induced liver injury. Her abdominal pain and encephalopathy resolved, and liver enzymes and INR improved significantly by discharge. At one-month follow-up, she remained asymptomatic, though liver tests were still mildly elevated.<br /><br />The discussion emphasizes that drug-induced liver injury is a leading cause of acute liver failure in the United States, and INH is a well-known cause despite its common use for latent TB. INH hepatotoxicity is idiosyncratic, not dose dependent, and most often occurs within the first few months of treatment. Risk factors include older age, female sex, Asian background, alcoholism, viral hepatitis, and slow acetylator status. Because there is no definitive treatment beyond discontinuation of the drug, clinicians should monitor carefully, stratify risk before prescribing INH, and educate patients about symptoms of liver injury.

Asset Subtitle

Kelly Suchman

Meta Tag

Author List Danielle Aronsky, Jobin Philipose, Kelly Suchman, Tai-Ping Lee

Category Clinical Vignettes

Concept Isoniazid

Concept Idiosyncratic drug-induced liver injury

Concept Acute Liver Failure

Concept Hepatocellular necrosis

Concept Drug Discontinuation

Distinguished Non-Finalist

Presenter Organization Donald and Barbara Zucker School of Medicine at Hofstra/Northwell - Hempstead, NY

Presenting Author Kelly Suchman

Track Adult

Keywords

isoniazid

acute liver failure

drug-induced liver injury

latent tuberculosis

hepatotoxicity

jaundice

transjugular liver biopsy

N-acetyl cysteine

submassive necrosis

liver dysfunction

Isoniazid

Idiosyncratic drug-induced liver injury

Acute Liver Failure

Hepatocellular necrosis

Drug Discontinuation