APPEARANCE OF RETINAL HEMORRHAGES IN PATIENTS ON DAILY-DOSE ANTI-TUBERCULAR THERAPY
Punita K Sodhi, Mahipal S Sachdev, Lalit K Verma, and Simmi K Ratan

OBJECTIVE: To report 2 patients who presented with retinal hemorrhages while being treated with a continuous regimen of anti-tuberculous drugs.

CASE SUMMARIES: Two women, one suffering from tuberculous infection of the lungs and the other from disseminated Koch's, were treated with a daily regimen of anti-tuberculous therapy consisting of rifampin, isoniazid, pyrazinamide, and ethambutol. On initiation of treatment, these patients did not have any systemic or ocular disease, and hematologic investigations, kidney function tests, and liver function tests were normal. Within 2 weeks of initiation of anti-tuberculous therapy, both women had transient renal function deterioration. Additionally, each had a single episode of retinal hemorrhage. While the patients remained under treatment with the same drugs, both of these adverse effects resolved spontaneously within a short period. According to the Naranjo probability scale, this reaction was probable.

DISCUSSION: The renal dysfunction and retinal hemorrhages in both of our patients were most probably due to anti-tuberculous drug-induced antibodies. A continuous mode of anti-tuberculous drug administration causes immunologic tolerance due to simultaneous neutralization of drug-induced antibodies. As the antibodies were short-lived, renal impairment, thrombocytopenia, and retinal hemorrhages in both of our patients were transient.

CONCLUSIONS: The continuous regimen of anti-tuberculous drug administration is safer than intermittent therapy. In patients receiving treatment with these drugs, hepatic, hematologic, renal, and ocular parameters should be regularly monitored.

J Pharm Technol 2004;20:276-9.