SAT0464 HEPATITIC SAFETY OF ANTI-TUBERCULOUS TREATMENT IN SPONDYLODISCITIS

Abstract

Background: Tunisia is considered as a country with high tuberculosis endemicity. The anti-tuberculous treatment is quite long and binding and requires close hepatic monitoring. Objectives: The purpose of this study was to highlight the hepatitic safety of anti-tuberculous treatment in tuberculous spondylodiscitis. Methods: This is a retrospective descriptive study, over 20 years (1999-2019) collating cases of tuberculous spondylodiscitis in a rheumatology department. We studied the epidemiological, clinical, radiological and therapeutic aspects. Results: Our study included 62 patients, 35 women and 27 men. Mean age was 56 years [16-86]. The diagnosis delay averaged 5.59 months [0.23-24]. Tuberculous contact was noted in 11.3% of the cases. Neurological abnormalities were noted in 16,1% of cases with spine compression in 3,22%. The tuberculin skin test was positive in 29 cases and the Koch bacillus investigations in the sputum and the urine were positive in only 3 patients. Magnetic resonance imaging was performed in 71% of the patients, and mainly showed images of disc destruction with images of abscess, epiduritis and epidural extension. Infectious spondylodiscitis affected the lumbar spine in 66.1% of the cases, the dorsal spine in 14.51% of the cases and the cervical spine in 6.55% of the cases. It was bi-staged in 19.35% of the cases and bifocal in 17.74% of the cases. Disco-vertebral biopsy was performed for 72.5% of patients and helped to make the diagnosis in 33.87% of the cases. All patients have received anti-tuberculosis treatment based on rifampicin, pyrazinamide, ethambutol and Isoniazid for an average duration of 2.8 months. Following the initial 4-drug regimen, most patients continued to receive a two-drug regimen with RMP and INH for a mean duration of nine months. Hepatotoxicity was seen in 13% : 11.4% of the patients had a history of cholestasis due to TB treatment, Only 2% of the patients had cytolysis. We nedded then to modify the treatment in 3,22%, and switch to triple anti-TB therapy based on Isoniazid, Rifampicin and ethambutol with a favorable evolution. No cases of hepatic insufficiency were noted. Conclusion: In our study, we note 8 cases of hepatotoxicity. The diagnosis of tuberculous spondylodiscitis requires urgent treatment with anti-tuberculosis antibiotics. However, it should be kept in mind that this treatment can lead to severe and life-threatening hepatotoxicity. Thus a rigorous monitoring of the treatment will be required. Disclosure of Interests: None declared