Ethambutol and isoniazid induced severe neurotoxicity in a patient undergoing continuous ambulatory peritoneal dialysis

BMJ Case Rep. 2018 May 18:2018:bcr2017223187. doi: 10.1136/bcr-2017-223187.

Abstract

Ethambutol (EMB) and isoniazid (INH) are the first-line antituberculosis (anti-TB) drugs. However, their neurotoxicity could cause adverse effect and the patients with end-stage renal disease are especially vulnerable due to the reduction in renal drug clearance. Here, we report a 36-year-old man receiving peritoneal dialysis developed progressive paralysis in lower extremities, vision loss and hoarseness 4 months after anti-TB treatment with INH, EMB and rifapentine because of concomitant pulmonary tuberculosis. A diagnosis of EMB/INH-induced peripheral neuropathy, retrobulbar neuritis and laryngoparalysis was made. The patient's neuropathy gradually improved 2 years after discontinuation of EMB/INH. Since EMB and INH may cause simultaneously severe and complex multineuropathy in dialysis patients, their adverse effects should be closely supervised in dialysis patients.

Keywords: dialysis; peripheral nerve disease; tuberculosis; unwanted effects / adverse reactions.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antitubercular Agents / adverse effects*
  • Ethambutol / adverse effects*
  • Humans
  • Isoniazid / adverse effects*
  • Kidney Failure, Chronic / microbiology
  • Kidney Failure, Chronic / therapy*
  • Male
  • Optic Neuritis / chemically induced*
  • Peripheral Nervous System Diseases / chemically induced*
  • Peritoneal Dialysis, Continuous Ambulatory / adverse effects*
  • Peritoneal Dialysis, Continuous Ambulatory / methods
  • Tuberculosis, Pulmonary / drug therapy
  • Vocal Cord Paralysis / chemically induced*

Substances

  • Antitubercular Agents
  • Ethambutol
  • Isoniazid