Drug-Induced Liver Injury in Young Female with Primary Tuberculous Lymphadenitis Mimicking Lymphatic Malignancy: A Case Study

Abstract

Background: Drug-induced liver injury (DILI) is a side effect that is often found in tuberculosis (TB) treatment and interferes the effectiveness of treatment. Risk factors for DILI during treatment of pulmonary tuberculosis are age, gender, and comorbid conditions such as hepatitis and use of hepatotoxic drugs. Case Report: A 22-year-old female presented with persistently enlarged, inflamed, painful right-sided neck swelling with purulent discharge for 7 months. The patient reported no history of comorbid diseases and risk factor other than passive smoking at home. Other symptoms are night sweats, loss of appetite, and significant weight loss. Initially, she was diagnosed with lymphatic malignancy, but after tissue sampling, she was diagnosed with tuberculous lymphadenitis without pulmonary TB based on histopathological examination, which revealed necrotizing granulomatous inflammation. GeneExpert was performed on sputum sample showing a negative result. The patient initially started first-line anti-TB therapy consisting of isoniazid, rifampin, pyrazinamide, and ethambutol. After 58 doses, the patient developed complaints of decreased appetite, nausea, and vomiting, without any improvement of the neck lumps. Laboratory results showed significant increase of ALT and AST. We diagnosed the patient with DILI and anti-tuberculosis drugs were stopped temporarily. Discussion: We present a unique case of a young woman, without comorbid chronic disease, with TB-lymphadenitis and DILI. DILI is a major side effect in TB treatment, causing therapy failure due to the non-adherence of treatment. A number of cohort studies have shown that the risk factors for DILI in patients receiving TB treatment are age>35 years, male gender, and history of comorbid disease such as hypertension and diabetes.