Isoniazid- and rifampicin-induced thrombocytopenia

Fatih Yakar,Zeki Kılıçaslan,Aysun Yakar,Namşan Yildiz

doi:10.1186/2049-6958-8-13

Abstract

Treatment of tuberculosis has many side effects. Thrombocytopenia is a serious side effect of such treatment and occurs mostly due to rifampicin (RIF). There are very few reported cases of thrombocytopenia due to isoniazid (INH). An 18-year-old female patient was diagnosed with smear-positive pulmonary tuberculosis. A four-drug regimen [INH, RIF, ethambutol (EMB), and pyrazinamide (PZA)] was given. After the development of thrombocytopenia, the drug treatment was stopped, and a thrombocyte suspension was given until a normal thrombocyte count was obtained. After several start-stop trials, first INH and then RIF were identified as the possible causes of thrombocytopenia and were removed from the regimen. The patient was treated with EMB, streptomycin, PZA, and moxifloxacin with no further development of thrombocytopenia. The current case shows that antituberculosis drugs other than RIF and PZA may be responsible for the development of thrombocytopenia.

Highlights

Tuberculosis is a chronic granulomatous infection that has caused mortality and morbidity for centuries
Rifampicin was assumed to be the causative factor of thrombocytopenia, and therapy was restarted with INH, PZA, and EMB
Discussion and conclusions there are reports of thrombocytopenia during antituberculosis treatment, only few case reports of INH-induced thrombocytopenia are reported [2,3,4,5], but none where the hematologic disorder was at the same time caused by INH and RIF

Summary

Introduction

Tuberculosis is a chronic granulomatous infection that has caused mortality and morbidity for centuries. We describe the case of a patient affected with thrombocytopenia caused by isoniazid (INH) and rifampicin (RIF). * Correspondence: fyakar@yahoo.com 1Department of Pulmonary Medicine, Bezmialem Vakif University, 34093, Fatih, Istanbul, Turkey Full list of author information is available at the end of the article (INH, 300 mg/day; RIF, 450 mg/day; ethambutol [EMB], 1,250 mg/day; and pyrazinamide [PZA], 1,500 mg/day) was started according to her weight of 50 kg.

Results

Conclusion