FATAL HEPATIC NECROSIS ASSOCIATED WITH AMINOSALICYLIC ACID

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Abstract
A woman with tuberculosis received treatment which included 10 Gm. of sodium aminosalicylic acid (PAS) daily. Headache with pain in the extremities appeared on the 18th day, fever on the 24th, backache and vomiting on the 25th. PAS therapy was discontinued on the 25th day, when the patient's temperature was 38.8 C (102 F), but one additional dose was taken, through error, on the 26th, whereupon a morbilliform rash appeared. Jaundice became evident on the 30th day and deepened until the 41st day, when she became irrational and comatose. Before death on the 49th day her temperature reached 40.5 C (105 F). Autopsy revealed severe acute toxic necrosis of the liver and active, moderately advanced pulmonary tuberculosis. The case here described is a sixth in the list of fatalities which the author finds attributed to PAS in the American literature. He also reports observations on four nonfatal cases of hepatitis caused by hypersensitivity to drugs, with either PAS or isoniazid involved. Fever, rash, or arthralgia may be the only warnings. By the time the rash has appeared and before the patient is jaundiced, irreversible and fatally progressive hepatitis may be under way. It is therefore necessary for the physician to be on his guard when using PAS to treat tuberculosis.

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