Anti-tubercular Agent for Intestinal Tuberculosis Induced Hepatotoxicity - A Case Report

Abstract

Tuberculosis (TB) is an endemic airborne disease. TB is the 13^th leading cause of death and second leading infectious killer after covid-19. Worldwide, 10.6 million people suffer from TB. Abdominal TB cases make up above 3% of all extrapulmonary TB as per the Index TB Guidelines. Abdominal tuberculosis is the type of extrapulmonary tuberculosis that is TB infection of any organ in the abdominal cavity. Intestinal tuberculosis is a rare clinical manifestation of extrapulmonary TB. A 63-year-old female patient was admitted with complaints of fatigue for one week. She had fever for one month on and off with significant loss of weight and had a recent history of deep vein thrombosis (DVT). Now she was newly detected with type 2 diabetes mellitus too. CECT scan of abdomen and pelvis was performed with findings of wall thickening of cecum and terminal ileum, mild splenomegaly, multiple adjacent enhancing mesenteric nodes, multiple enlarged enhancing conglomerated para-aortic, retroperitoneal and common iliac nodes, multiple short discontinuous segments of bowel wall thickening with luminal narrowing involving ascending, transverse, and descending colon. A detailed examination of colonoscopy concluded intestinal tuberculosis. Although Expert MTB/RIF ultra-extrapulmonary showed MTB not detected as well as the rifampicin resistance not detected. MTB treatment was initiated. After the drug was taken, it resulted in hepatitis, that is, ATT-induced hepatitis. Therefore, the particular drug was stopped, and an alternative was started. This case points out the diagnostic challenges of intestinal tuberculosis and commonly caused antitubercular agent-induced hepatotoxicity. In this case, it took time to find out the disease condition, and after starting the TB drugs, which led to hepatotoxicity, this further led to the elongation of the treatment duration.