• Yeh-Chin Wang, Kai-Hsiang Chen, Yen-Lin Chen, Shu-Wen Lin, Wang-Da Liu, Jann-Tay Wang, and Chien-Ching Hung.
• Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
• Medicine (Baltimore). 2022 Sep 30; 101 (39): e30955e30955.

RationaleDrug induced liver injury (DILI) is a common side effect causing treatment discontinuation during tuberculosis (TB) treatment, and pyrazinamide (PZA) usually leads to a delayed and prolonged abnormal liver function of the 4 standard anti-tuberculosis regimens. However, a prolonged hepatitis lasting more than 4 months is rarely reported.Patient ConcernsA 78-year-old man presented with general weakness and poor appetite on his seventh week of anti-TB treatment for tuberculosis lymphadenitis.DiagnosisDrug induced liver injury, PZA-related. NAT2 slow acetylator phenotype was accidentally found during workup of DILI.InterventionA liver biopsy was performed and PZA-related DILI was suspected. All anti-TB medications were therefore discontinued.OutcomeAfter withholding all anti-TB medications for 4 months, the elevations of aminotransferases and hyperbilirubinemia completely resolved. Anti-TB therapy was switched to ethambutol and levofloxacin for 15 months without adverse events. Long-term ultrasound follow-up was performed and cervical lymphadenopathy completely resolved.ConclusionOur patient presents with PZA related prolonged DILI resolved after drug discontinuation for 4 months. NAT2 slow acetylator phenotype may be related to this condition through unknown mechanisms.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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