CONVULSIVE REACTION IN A TWO-YEAR-OLD CHILD FOLLOWING THE ACCIDENTAL INGESTION OF AN OVERDOSAGE OF ISONIAZID

Abstract

S. K., a 26-month-old white male, was admitted to the hospital because of several generalized convulsions in the preceding hour. The mother had tuberculous pleurisy with effusion in 1938. The father had pulmonary tuberculosis with cavitation in 1933 for which pneumothorax was induced from 1934 to 1939 and a lobectomy performed in 1940. Since 1942 neither parent showed signs of active tuberculosis. The patient was one of twins born 3 weeks prematurely by breech presentation. Birth weight was 1,955 gm. He breathed and cried spontaneously. The neonatal period was eventful, development was entirely normal and there were no serious illnesses or convulsions. Because of the family history of tuberculosis, the patient and 3 siblings were vaccinated on June 18, 1954 with 1/16 ml. of Rosenthal's B.C.G. vaccine (dry freeze), intradermally. Tuberculin tests preceding vaccination were negative and became positive by September 11, 1954. Because the patient had a continuously draining ulcer at the site of vaccination and a large, tender, fluctuant axillary lymph node, treatment was started with streptomycin sulfate 250 mg. twice weekly and 50 mg. of isoniazid t.i.d. on August 4. On September 11, the streptomycin sulfate was reduced to 125 mg. twice weekly, but the isoniazid was continued at the original dosage. This regimen of therapy was maintained until admission to the hospital on November 1. About 1 hour before admission, the patient vomited several times while riding in the car with his mother. Shortly after this, the mother noted that ho seemed less alert and responsive than usual. He then had 3 generalized clonic convulsions in rapid succession, following which he became unconscious. He was brought immediately to the hospital.