异烟肼相关多器官功能障碍综合征

1例74岁女性患者,因结核性胸膜炎给予链霉素、异烟肼、利福平及吡嗪酰胺。用药1周后出现肝肾损害。停用抗结核药,肝肾功能恢复正常。再次抗结核治疗,出现发热及皮肤瘙痒。停药及抗过敏治疗后症状好转。再次口服异烟肼0.2g,吡嗪酰胺1.0g,乙胺丁醇0.75g。30min后出现畏寒、发热、恶心、呕吐,意识障碍,唇周发绀。T40.5℃,P120次/min。随后出现少尿,颈强直;左侧上、下肢肌力2级,右侧上、下肢肌力0级。实验室检查：ALT41U/L,AST99U/L,BUN13.57mmol/L,SCr481μmol/L;肌红蛋白2470μg/L,肌钙蛋白0.52μg/L,LDH442U/L,α-羟丁酸脱氢酶315U/L,CK2789U/L,CK-MB50U/L,血清淀粉酶384U/L。行对症支持治疗,2d后症状好转。再次给予吡嗪酰胺、乙胺丁醇、左氧氟沙星抗结核治疗,治疗2个月未出现不良反应。

Multiple organ dysfunction syndrome associated with isoniazid

A 74-year-old woman with tuberculosis pleuritis received streptomycin,isoniazid,rifampin,and pyrazinamide. After one week of therapy,her liver and renal damage occurred. Antituberculous drugs were stopped and her liver and renal functions normalized. Antituberculous treatment was given again and the patient developed fever and skin pruritis. Her symptoms improved after discontinuing these drugs and receiving anti-allergic treatment. Then she was administered isoniazid 0. 2 g,pyrazinamide 1. 0 g, ethambutol 0. 75 g. Thirty minutes later,she experienced cold intolerance,fever,nausea,vomiting,confusion,and lip cyanosis. Her termperature was 40. 5℃ and pulse was 120 beats/min. Subsequently,the patient presented with oliguresis,cervical rigidity. Her muscle strength was grade 2 in left upper and lower limbs while grade 0 in right upper and lower limbs. Laboratory tests revealed the following levels and values： ALT 41 U/L,AST 99 U/L,BUN 13. 57 mmol/L,SCr 481 μmol/L,myoglobin 2 470 μg/L,troponin 0. 52 μg/L,LDH 442 U/L,α-hydroxybutyric dehydrogenase 315 U/L,CK 2 789 U/L,CK-MB 50 U/L,and serum amylase 384 U/L. She was treated with symptomatic and supportive therapies and,two days later,her conditions relieved. Antituberculous treatment with pyrazinamide,ethambutol,levofloxacin was given again and there was no recurrence of any adverse reactions after further two months of treatments