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.