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A.G. Holley Hospital
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Case 4
James, 45 y.o., hx of alcohol abuse diagnosed with active tb. Baseline lft’s
normal. Stafter 1 month of therapy, ast, alt and total bilirubin were 6x, 3x,and 2x normal
respectively. He abdominal sonogram: enlarged liver, normal gallbladder, duct and
pancreas. Hepatitis c ab positive, hiv every time rifampin was re-introduced,
transaminases and bilirubin rose againLiver biopsy showed active inflammation,
cirrhosis, consistent with hepatitis c and alcohol-induced damage. ?-interferon was
started, with normalization of liver function tests
Iantituberculosis therapy is generally well tolerated, but toxicity occurs. If side
effects/toxicity appear, initiate methodical diagnostic evaluation, treat accordingly.
When in doubt, stop drugs temporarily, reassess, and get expert help!!!. Nh and rifabutin
restarted uneventfully
Hep c ribosomal rna @ high levelswas icteric, febrile and had an enlarged, tender
liverarted on inh, rifampin, ethambutol and pyrazinamide.
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