Fulminant hepatitis during treatment for per-extensively drug-resistant tuberculosis: A case report and call for improved patient monitoring

Rationale Drug therapy is the most effective therapy for tuberculosis; however, it can also lead to a common and serious adverse reaction known as antituberculosis drug-induced liver injury. The incidence of antituberculosis drug-induced liver injury ranges from 2.0% to 28.0%. Patient concerns Here, we report the successful treatment of drug-induced fulminant hepatitis in a 19-year-old patient with extensively drug-resistant tuberculosis. Diagnoses The patient was treated with a combination of bedaquiline, linezolid, cycloserine, clofazimine, amikacin, ethambutol, and pyrazinamide. This combination was selected because the patient showed resistance to rifampicin, isoniazid, and fluoroquinolones in a drug resistance test. However, for personal reasons, the patient did not follow the doctor's advice and developed fulminant hepatitis induced by antituberculosis drugs. Interventions Antituberculosis drugs were immediately discontinued, and the patient received clinical treatment for liver protection, jaundice elimination, artificial liver support, and infusion of fibrinogen and prothrombin complex. Outcomes Gradually, the patient's liver function returned to normal. Lessons This case report highlights the importance of regular liver function monitoring during antituberculosis therapy to ensure patient safety.