Abstract:

Objective: To analyze the clinical features, therapeutic measures and prognosis of anti-tuberculosis therapy-associated acute liver failure in children with tuberculosis. Methods: The clinical manifestations, examination results, therapeutic measures and prognosis of three children with anti-tuberculosis therapy-associated acute liver failure were reported. Literatures were reviewed on the published reports between January 1980 and December 2021 by searching with the key words of “acute liver failure, tuberculosis, child/children” in Wanfang, WPCS, CNKI and PubMed. Information was collected, including the patient’s age, anti-tuberculosis treatment plan, duration of taking anti-tuberculosis drug, usage of other drugs that can cause liver injury, and treatment outcome, etc. Cases of liver failure caused by tuberculosis preventive treatment were excluded. Results: Three patients were admitted to our hospital, including 1 boy and 2 girls.Tuberculosis was involved in thoracic, abdominal cavity in 3 children and involved in central nervous system in in 2 children. All the three cases had hypoproteinemia. After treatment, 2 died and 1 survived. Through literature review, the data of 6 cases were obtained. The total number of subjects was 9 cases, including three cases reported above. The age of 9 cases ranged from 0.25 to 12.80 years, and the median age (quartile) was 10.70 (5.02, 12.70) years. Four cases were treated with H-R-E-Z (H: isoniazid, R: rifampin, E: ethambutol, Z: pyrazinamide) regimen, and the other five were treated with H-R (2 cases), H-R-Z (2 cases), and H-R-E-S (S: streptomycin; 1 case). In this study, four cases survived and five died. Of the three cases aged <10 years old, two died and one who received liver transplantation survived. Conclusion: Anti-tuberculosis therapy-associated acute liver failure in children mainly occurred within 1 months after taking anti-tuberculous drugs. The younger the case, the worse the prognosis of liver failure.

Key words: Child, Antitubercular agents, Drug toxicity, Liver failure, Case reports