Difficulties in management of tuberculous pneumonia in a patient with liver failure in the course of chronic hepatitis B and concomitant failure of the transplanted kidney

Abstract

A 62-year-old woman with liver failure in the course of chronic hepatitis B and concomitant failure of the transplanted kidney was treated for tuberculous pneumonia. The treatment was initiated with rifampin, isoniazid and pyrazinamide. Both renal and hepatic side effects required modification of this scheme. After 1 month of treatment sputum smears tested for acid-fast bacilli converted to a negative result and the chest X-ray demonstrated complete resolution of pulmonary infiltrates. Further therapy resulted in serious deterioration of the liver failure and fatal outcome.A 62-year-old woman with liver failure in the course of chronic hepatitis B and concomitant failure of the transplanted kidney was treated for tuberculous pneumonia. The treatment was initiated with rifampin, isoniazid and pyrazinamide. Both renal and hepatic side effects required modification of this scheme. After 1 month of treatment sputum smears tested for acid-fast bacilli converted to a negative result and the chest X-ray demonstrated complete resolution of pulmonary infiltrates. Further therapy resulted in serious deterioration of the liver failure and fatal outcome