Abstract
The mechanisms underlying isoniazid (INH)-induced hepatitis were studied. INH-induced hepatitis is known to occur due to the production of hepatotoxic metabolites in slow acetylators of INH, and hepatitis due to hypersensitivity reactions is also suspected to occur. The latter type of hepatitis was diagnosed by the presence of allergic reactions and a positive lymphocyte transformation test (LTT), while the former type was diagnosed by the absence of allergic symptoms and a negative LTT. Among 14 patients with INH-induced hepatitis, nine had hepatitis due to abnormal metabolism of INH and five had hypersensitivity reactions. Comparison was made with a control group of 276 patients who had drug-induced hepatic injury caused by hypersensitivity reactions to various other drugs. The metabolic group showed milder liver dysfunction than the control group. Hypersensitivity patients showed a disease state similar to the controls, and jaundice was more common in the hypersensitivity group than in the metabolic group. These findings suggest that there are two distinct disease states in patients with INH-induced hepatitis, and that INH can cause mild liver damage due to abnormal handling of its metabolites or relatively severe hepatitis due to hypersensitivity reactions.
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