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Isoniazid-Induced Acute Pancreatitis
- Alfredo A. Rabassa, MD;
- Gary Trey, MD;
- Urmil Shukla, MD;
- Tobias Samo, MD; and
- Bhupinderjit S. Anand, MD
- From Baylor College of Medicine, Houston, Texas. Requests for Reprints: Bhupinderjit S. Anand, MD, Gastroenterology Section, Smith Tower, 6550 Fannin, SM 1122, Houston, TX 77030.
In recent years, a resurgence of Mycobacterium tuberculosis has occurred in the United States [1], resulting in a marked increase in the use of antituberculous drugs. Isoniazid is a first-line drug in the treatment of tuberculosis and is increasingly being used as a chemoprophylactic agent. Severe adverse reactions with isoniazid have been observed; these include hepatitis, peripheral neuropathy, skin rashes, neurologic disturbances, and hematologic alterations [2, 3]. We describe a patient with the first well-documented case of isoniazid-induced acute pancreatitis.
Case Report
A 31-year-old man from India presented to the emergency department with complaints of several days of weakness, fever, vomiting, and persistent pain in the epigastrium. Three weeks before this presentation, he was seen in the same hospital with complaints of persistent diarrhea, fever, and a weight loss of 7 kg. The patient had a positive tuberculin test result of 13 millimeters. Endoscopy showed aphthous ulcers in the duodenum, terminal ileum, and ileocecal valve. Antituberculous medications were begun, and his diarrhea and fever resolved. Follow-up endoscopy showed complete resolution of aphthous ulcers.
At the time of his presentation to the emergency department, the patient had received 14 days of daily rifampin (600 mg), isoniazid (300 mg), and pyrazinamide (1500 mg). He denied any history of alcohol ingestion, abdominal trauma, abnormal lipid test results, and gallbladder or pancreatic …
