Vol. 7, Issue 2, Part E (2025)

Background: Anti-tuberculosis therapy (ATT) is essential for treating pulmonary tuberculosis but is often associated with adverse drug reactions (ADRs). Hepatotoxicity and gastrointestinal (GI) intolerance are among the most frequent complications. Their concurrent occurrence, however, poses diagnostic and therapeutic challenges.

Case Presentation: A 60-year-old male with microbiologically confirmed pulmonary tuberculosis was started on first-line ATT. Within 10 days, he developed recurrent vomiting, abdominal pain, loss of appetite, giddiness, fatigue, and shortness of breath. On admission, he was conscious, oriented, afebrile, and hemodynamically stable. Abdominal examination revealed diffuse tenderness. Laboratory investigations showed marked hyperbilirubinemia (total bilirubin 10.6 mg/dL, direct bilirubin 6.6 mg/dL), elevated transaminases (AST 173 U/L, ALT 87 U/L), raised alkaline phosphatase (223 U/L), hypoalbuminemia (3.0 g/dL), and altered A/G ratio. These findings indicated drug-induced liver injury. The gastrointestinal symptoms, occurring soon after ATT intake, were consistent with drug-induced gastritis.

ATT was discontinued, and the patient was managed with intravenous pantoprazole and ondansetron, along with oral ursodeoxycholic acid and N-acetylcysteine. He showed progressive symptomatic and biochemical improvement after withdrawal of the offending drugs. Further management included close monitoring of liver function tests with plans for reintroduction of modified ATT once hepatic function normalized.

Conclusion: This case highlights the dual presentation of ATT-induced gastritis and hepatotoxicity, emphasizing the need for clinicians to remain vigilant when patients develop persistent gastrointestinal complaints during therapy. Such symptoms may represent early warning signs of liver injury. Early recognition, prompt drug withdrawal, and timely supportive management are critical to prevent severe complications and to enable safe continuation of tuberculosis treatment.