Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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A Case of Pyrazinamide Induced Fulminant Hepatic Failure

Pyrazinamide에 의한 전격성 간부전 1예

  • Moon, Dae Sung (Department of Internal Medicine, College of Medicine, Kosin University) ;
  • Jang, Tae Won (Department of Internal Medicine, College of Medicine, Kosin University) ;
  • Oak, Chul Ho (Department of Internal Medicine, College of Medicine, Kosin University) ;
  • Jung, Maan Hong (Department of Internal Medicine, College of Medicine, Kosin University) ;
  • Yoo, Chan Hui (Department of Internal Medicine, College of Medicine, Kosin University) ;
  • Song, Jun Young (Department of Internal Medicine, College of Medicine, Kosin University) ;
  • Kim, Sung Eun (Department of Internal Medicine, College of Medicine, Kosin University) ;
  • Kim, Ja Kyung (Department of Internal Medicine, College of Medicine, Kosin University) ;
  • Jang, Lee La (Department of Internal Medicine, College of Medicine, Kosin University) ;
  • Lee, Eun Young (Department of Internal Medicine, College of Medicine, Kosin University) ;
  • Jung, Gyu Sik (Department of Radiology, College of Medicine, Kosin University)
  • 문대성 (고신대학교 의과대학 내과학교실) ;
  • 장태원 (고신대학교 의과대학 내과학교실) ;
  • 옥철호 (고신대학교 의과대학 내과학교실) ;
  • 정만홍 (고신대학교 의과대학 내과학교실) ;
  • 유찬희 (고신대학교 의과대학 내과학교실) ;
  • 송준영 (고신대학교 의과대학 내과학교실) ;
  • 김성은 (고신대학교 의과대학 내과학교실) ;
  • 김자경 (고신대학교 의과대학 내과학교실) ;
  • 장리라 (고신대학교 의과대학 내과학교실) ;
  • 이은영 (고신대학교 의과대학 내과학교실) ;
  • 정규식 (고신대학교 의과대학 방사선학교실)
  • Received : 2007.09.10
  • Accepted : 2007.10.09
  • Published : 2007.11.30
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Abstract

Standard antituberculous therapy, including isoniazid (INH), rifampin, ethambutol, and pyrazinamide (PZA), is widely used to treat active tuberculosis. The most important side effect is hepatotoxicity. In a standard four-drug regimen, PZA was the most common cause of drug-induced hepatitis and was dose-related. The incidence of drug-induced hepatitis is high at doses of 40~70 mg/kg per day but has fallen significantly since the recommended dose was reduced. Liver toxicity induced by PZA is rare at doses of 25 mg/kg per day or less. PZA-induced fulminant hepatic failure is also rare but fatal. We report a case of fulminant hepatic failure caused by a re-challenge of PZA.

PZA에 의한 독성 간염은 약 2% 정도 보고되고 있으나 전격성 간염으로 진행하여 사망하는 경우는 드물게 보고되고 있다. 본 증례에서는 항결핵제에 의해 중증 독성 간염을 보였다가 회복된 후 저용량의 PZA을 재투여 하고 전격성 간염으로 진행하는 양상을 보였다. 이번 사례를 통해 저용량의 PZA를 투약시 전격성 간부전으로 진행하는 경우를 경험했고 항결핵제 투여시 면밀한 관찰이 필요하고 항결핵 약제 투여시 신중을 기울여야겠다.

Keywords

References

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