Published online May 12, 2008
PEDIATRICS (doi:10.1542/peds.2007-2773)
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EXPERIENCE & REASON

Unintended Consequences: Mandatory Tuberculin Skin Testing and Severe Isoniazid Hepatotoxicity

Mark N. Lobato, MDa, John A. Jereb, MDa and Jeffrey R. Starke, MDb

a Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia
b Department of Pediatrics, Baylor College of Medicine, Houston, Texas

ABSTRACT

After mandatory school-enrollment tuberculin skin testing, a 4-year-old girl who was at low risk for Mycobacterium tuberculosis infection had severe isoniazid hepatotoxicity that was managed with a liver transplant. Although severe isoniazid hepatotoxicity is very uncommon in children, this case emphasizes the need to limit skin testing to persons who have a risk factor for infection and to educate parents on how to monitor for adverse effects during treatment.

Key Words: latent tuberculosis infection • prevention • tuberculin skin test • isoniazid • hepatotoxicity • liver transplantation

Abbreviations: TST, tuberculin skin test • LTBI, latent tuberculosis infection • AAP, American Academy of Pediatrics • CDC, Centers for Disease Control and Prevention

Accepted Nov 26, 2007.




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jayendra Gohil
Pediatrics Online, 16 Jun 2008 [Full text]