Toxic liver damage from tuberculostatic agents – case report of a patient, who developed liver failure

Authors

  • D. Lyubomirova Clinic of Gastroenterology, University Hospital „Dr. Georgi Stranski“ – Pleven Author
  • E. Borisova Clinic of Pneumology and Phthisiology, University Hospital „Dr. Georgi Stranski“ – Pleven Author
  • Y. Ivanov Clinic of Pneumology and Phthisiology, University Hospital „Dr. Georgi Stranski“ – Pleven Author

Keywords:

toxic liver damage, drug-induced liver injury, tuberculostatics, liver failure

Abstract

Toxic liver damage or DILI (drug-induced liver injury) is a type of liver injury, caused by drugs or nonmedicinal plant products or other xenobiotic agents. The clinical course of the toxic liver damage may vary between asymptomatic elevation of the liver enzymes to liver insufficiency and death. The current article reports a heavy case of liver insufficiency, which developed as a side effect by the use of tuberculostatic treatment of tuberculosis and at the same time offers an overview on the contemporary clinical and histological classifications for DILI and prognostic signs for the outcome of the latter. The aim of the article is to drag the attention to the multiple predisposing factors for the development of the different types of liver injury and the fact that despite the known scientifical data, we should always have in mind heavy course and lethal end by the prescription of every product – medicinal, plant-based and especially by those, which are known as hepatotoxins.

References

Villanueva-Paz M, Morán L, López-Alcántara N, et al. Oxidative Stress in Drug-Induced Liver Injury (DILI): From Mechanisms to Biomarkers for Use in Clinical Practice. Antioxidants. 2021; 10(3):390. https://doi.org/10.3390/antiox10030390

Devarbhavi H, Asrani SK, Arab JP, et al. Global burden of liver disease: 2023 update. J Hepatol. 2023 Aug;79(2):516-537. doi: 10.1016/j.jhep.2023.03.017.

Garcia-Cortes M, Robles-Diaz M, Stephens C, et al. Drug induced liver injury: An update. Arch. Toxicol. 2020.

Sgro C, Clinard F. Ouazir K, et al. Incidence of drug-induced hepatic injuries: A French population-based study. Hepatology 2002, 36, 451-455.

Aleo MD, Luo Y, Swiss R, et al. Human drug-induced liver injury severity is highly associated with dual inhibition of livermitochondrial function and bile salt export pump. Hepatology 2014, 60, 1015-1022.

Köck K; Ferslew BC, Netterberg I, et al. Risk factors for development of cholestatic drug-induced liver injury: Inhibition of hepatic basolateral bile acid transporters multidrug resistance-associated proteins 3 and 4. Drug Metab Dispos. 2014, 42, 665-674.

Iorga A, Dara L, Kaplowitz N. Drug-Induced Liver Injury: Cascade of Events Leading to Cell Death, Apoptosis or Necrosis. Int. J. Mol. Sci. 2017, 18, 1018.

Wuillemin N, Adam J, Fontana S, et al. HLA haplotype determines hapten or p-i T cell reactivity to flucloxacillin. J. Immunol. 2013, 190, 4956-4964.

Mak A, Uetrecht J. Immune mechanisms of idiosyncratic druginduced liver injury. J. Clin. Transl. Res. 2017, 3, 145-156.

Chalasani N, Bonkovsky HL, Fontana R, et al. Features and Outcomes of 899 Patients With Drug-Induced Liver Injury: The DILIN Prospective Study. Gastroenterology 2015, 148, 1340-1352.e7.

Lucena MI, Andrade RJ, Kaplowitz N, et al. Phenotypic characterization of idiosyncratic drug-induced liver injury: The influence of age and sex. Hepatology 2009, 49, 2001-2009.

Garcia-Cortes M, Stephens C, Lucena MI, et al. Causality assessment methods in drug induced liver injury: Strengths and weaknesses. J. Hepatol. 2011, 55, 683-691.

Huang YS, Chern HD, Su WJ, et al. Polymorphism of the N-acetyltransferase 2 gene as a susceptibility risk factor for antituberculosis drug-induced hepatitis. Hepatology 2002, 35, 883-889.

Teschke R, Eickhoff A. Herbal hepatotoxicity in traditional and modern medicine: Actual key issues and new encouraging steps. Front. Pharmacol. 2015, 6, 72.

Navarro VJ, Lucena MI. Hepatotoxicity induced by herbal and dietary supplements. Semin. Liver Dis. 2014, 34, 172-193.

Daly AK, Aithal GP, Leathart JB, et al. Genetic susceptibility to diclofenac-induced hepatotoxicity: Contribution of UGT2B7, CYP2C8, and ABCC2 genotypes. Gastroenterology 2007, 132, 272-281.

Kaliyaperumal K, Grove JI, Delahay RM, et al. Pharmacogenomics of drug-induced liver injury (DILI): Molecular biology to clinical applications. J. Hepatol. 2018, 69, 948-957.

Hosack T, Damry D, Biswas S. Drug-induced liver injury: a comprehensive review. Therap Adv Gastroenterol. 2023 Mar 21;16:17562848231163410. doi: 10.1177/17562848231163410.

Lee WM. Drug-induced acute liver failure. Clin Liver Dis 2013; 17: 575-586.

Andrade RJ, Aithal GP, Björnsson ES, et al. EASL clinical practice guidelines: drug-induced liver injury. J Hepatol 2019; 70: 1222-1261.

Drug-Induced Liver Injury (DILI): Current Status and Future Directions for Drug Development and the Post-Market Setting;

A Consensus by a CIOMS Working Group; Council for International Organizations of Medical Sciences (CIOMS): Geneva, Switzerland, 2020.

Danan G, Benichou C. Causality assessment of adverse reactions to drugs-I. A novel method based on the conclusions of international consensus meetings: Application to drug-induced liver injuries. J. Clin. Epidemiol. 1993, 46, 1323-1330.

Kleiner DE, Chalasani NP, Lee WM, et al. Drug-Induced Liver Injury Network (DILIN). Hepatic histological findings in suspected drug-induced liver injury: systematic evaluation and clinical associations. Hepatology. 2014 Feb;59(2):661-70.

Medina-Caliz I, Robles-Diaz M, Garcia-Muñoz B, et al.; Spanish DILI registry. Definition and risk factors for chronicity following acute idiosyncratic drug-induced liver injury. J Hepatol. 2016 Sep;65(3):532-42. doi: 10.1016/j.jhep.2016.05.003. Epub 2016 May 13.

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Published

15.06.2026

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Section

Case reports

How to Cite

Lyubomirova, D., Borisova, E., & Ivanov, Y. (2026). Toxic liver damage from tuberculostatic agents – case report of a patient, who developed liver failure. Medical Review, 62(4), 42-49. https://journals.mu-sofia.bg/index.php/mr/article/view/903