ETHAMBUTOL INDUCED OPTIC NEUROPATHY IN ANKLE TUBERCULOSIS PATIENT- A CASE REPORT
Main Article Content
Keywords
Ankle tuberculosis, Antitubercular therapy, Ethambutol, Optic Neuropathy
Abstract
Introduction: Tuberculosis is mainly treated by antitubercular therapy with 2month of intensive regimen with Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol, followed by 4months of maintenance therapy with Isoniazid, Rifampicin and possible extended therapy for ankle tuberculosis. Ethambutol is a potent bacteriostatic antitubercular agent. It is known to cause Ethambutol induced optic neuropathy.
Case: A 61year old female patient was diagnosed with ankle tuberculosis and on anti-tubercular therapy for 2months had complete joint damage, underwent left ankle arthrotomy with biopsy and ankle arthrodesis. After 3 months of antitubercular therapy patient had blurring of vision. Patient ophthalmological examination showed optic neuropathy. Since there being no identifiable reason for optic neuropathy it was attributed to ethambutol.
Conclusion: Though ethambutol is categorised as drug with mild adverse effects it can cause serious visual loss with no definitive treatment and variable recovery. Hence clinicans should be observant and prevent visual loss by early diagnosis and withdrawal of the drug immediately.
References
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9 Leibold JE. The ocular toxicity of ethambutol and its relation to dose. Annals of the New York Academy of Sciences. 1966 Apr;135(2):904-9.
10 Saxena R, Singh D, Phuljhele S, Kalaiselvan V, Karna S, Gandhi R, Prakash A, Lodha R, Mohan A, Menon V, Garg R. Ethambutol toxicity: Expert panel consensus for the primary prevention, diagnosis and management of ethambutol-induced optic neuropathy. Indian journal of ophthalmology. 2021 Dec 1;69(12):3734-9.
11 Sabhapandit S, Gella V, Shireesha A, Thankachan L, Ismail M, Rao R, Talukdar R. Ethambutol optic neuropathy in the extended anti-tubercular therapy regime: A systematic review. Indian journal of ophthalmology. 2023 Mar 1;71(3):729-35.
12 Pai M, Behr MA, Dowdy D, Dheda K, Divangahi M, Boehme CC. Nature reviews disease primers. Tuberculosis. 2016;2:16076.
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13 Ludwig B, Lazarus AA. Musculoskeletal tuberculosis. Disease-a-month: DM. 2007 Jan;53(1):39-45.
14 Nogdallah S, Mustafa ME, Khairy AM, Fatooh M, Abd‐Elmaged HM. Foot and ankle tuberculosis: A case report and review of the literature. Clinical Case Reports. 2023 Jun;11(6):e7483.
15 Dhillon MS, Tuli SM. Osteoarticular tuberculosis of the foot and ankle. Foot & Ankle International. 2001 Aug;22(8):679-86.
16 Conradie F, Diacon AH, Ngubane N, Howell P, Everitt D, Crook AM, Mendel CM, Egizi E, Moreira J, Timm J, McHugh TD. Treatment of highly drug-resistant pulmonary tuberculosis. New England Journal of Medicine. 2020 Mar 5;382(10):893-902.
17 Conradie F, Diacon AH, Ngubane N, Howell P, Everitt D, Crook AM, Mendel CM, Egizi E, Moreira J, Timm J, McHugh TD. Treatment of highly drug-resistant pulmonary tuberculosis. New England Journal of Medicine. 2020 Mar 5;382(10):893-902.
8 Lee N, Nguyen H. Ethambutol. [Updated 2022 Oct 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/ NBK559050/
18 National Centre for Biotechnology Information (2021). Ethambutol, PubChem compound summary for CID 14052.
19 Nagarajan S, Whitaker P. Management of adverse reactions to first-line tuberculosis antibiotics. Current opinion in allergy and clinical immunology. 2018 Aug 1;18(4):333-41.
20 Xiang Y, Ma L, Wu W, Liu W, Li Y, Zhu X, Wang Q, Ma J, Cao M, Wang Q, Yao X. The incidence of liver injury in Uyghur patients treated for TB in Xinjiang Uyghur autonomous region, China, and its association with hepatic enzyme polymorphisms nat2, cyp2e1, gstm1 and gstt1. PloS one. 2014 Jan 23;9(1):e85905
21 Chen SC, Lin MC, Sheu SJ. Incidence and prognostic factor of ethambutol-related optic neuropathy: 10-year experience in southern Taiwan. The Kaohsiung journal of medical sciences. 2015 Jul 1;31(7):358-62.
22 Donald PR, Maher D, Maritz JS, Qazi S. Ethambutol dosage for the treatment of children: literature review and recommendations. The International Journal of Tuberculosis and Lung Disease. 2006 Dec 1;10(12):1318-30.
23 Chamberlain PD, Sadaka A, Berry S, Lee AG. Ethambutol optic neuropathy. Current opinion in ophthalmology. 2017 Nov 1;28(6):545-51.
24 Koul PA. Ocular toxicity with ethambutol therapy: Timely recaution. Lung India: Official Organ of Indian Chest Society. 2015 Jan;32(1):1.
25 Ezer N, Benedetti A, Darvish-Zargar M, Menzies D. Incidence of ethambutol-related visual impairment during treatment of active tuberculosis. The International journal of tuberculosis and lung disease. 2013 Apr 1;17(4):447-55.
26 Kim U, Hwang JM. Early stage ethambutol optic neuropathy: retinal nerve fiber layer and optical coherence tomography. European journal of ophthalmology. 2009 May;19(3):466-9.
27 Chai SJ, Foroozan R. Decreased retinal nerve fibre layer thickness detected by optical coherence tomography in patients with ethambutol-induced optic neuropathy. British journal of ophthalmology. 2007 Jul 1;91(7):895-7.
28 Abbasi Nazari M, Kobarfard F, Tabarsi P, Salamzadeh J. Serum copper (cu) alterations in pulmonary tuberculosis patients under treatment with ethambutol. Biological trace element research. 2009 May;128:161-6.
29 Chen HY, Lai SW, Muo CH, Chen PC, Wang IJ. Ethambutol-induced optic neuropathy: a nationwide population-based study from Taiwan. British journal of ophthalmology. 2012 Nov 1;96(11):1368-71.
30 Azar FM, Canale ST, Beaty JH. Campbell's Operative Orthopaedics, E-Book. Elsevier Health Sciences; 2020 Dec 23.
31 TSAI RK, LEE YH. Reversibility of ethambutol optic neuropathy. Journal of ocular pharmacology and therapeutics. 1997 Oct;13(5):473-7.
2 Faroug R, Psyllakis P, Gulati A, Makvana S, Pareek M, Mangwani J. Diagnosis and treatment of tuberculosis of the foot and ankle—a literature review. The Foot. 2018 Dec 1;37:105-12.
3 Tripathi KD. Antitubercular Drugs. Essential of Medical pharmacology, seventh edition. Jaypee Brothers Medical Publishers (P) Ltd, India. Essentials of Medical Pharmacology; 2013. p. 765.
4 Lee A, Xie YL, Barry CE, Chen RY. Current and future treatments for tuberculosis. bmj. 2020 Mar 2;368.
5 Sharma SK, Ryan H, Khaparde S, Sachdeva KS, Singh AD, Mohan A, Sarin R, Paramasivan CN, Kumar P, Nischal N, Khatiwada S. Index-TB guidelines: guidelines on extrapulmonary tuberculosis for India. The Indian journal of medical research. 2017 Apr;145(4):448-63.
6 Yang TW, Park HO, Jang HN, Yang JH, Kim SH, Moon SH, Byun JH, Lee CE, Kim JW, Kang DH. Side effects associated with the treatment of multidrug-resistant tuberculosis at a tuberculosis referral hospital in South Korea: A retrospective study. Medicine. 2017 Jul 1;96(28):e7482.
7 Barliana MI, Afifah NN, Yunivita V, Ruslami R. Genetic polymorphism related to ethambutol outcomes and susceptibility to toxicity. Frontiers in Genetics. 2023 Apr 20;14:1118102.
8 Lee N, Nguyen H. Ethambutol. [Updated 2022 Oct 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/ NBK559050/
9 Leibold JE. The ocular toxicity of ethambutol and its relation to dose. Annals of the New York Academy of Sciences. 1966 Apr;135(2):904-9.
10 Saxena R, Singh D, Phuljhele S, Kalaiselvan V, Karna S, Gandhi R, Prakash A, Lodha R, Mohan A, Menon V, Garg R. Ethambutol toxicity: Expert panel consensus for the primary prevention, diagnosis and management of ethambutol-induced optic neuropathy. Indian journal of ophthalmology. 2021 Dec 1;69(12):3734-9.
11 Sabhapandit S, Gella V, Shireesha A, Thankachan L, Ismail M, Rao R, Talukdar R. Ethambutol optic neuropathy in the extended anti-tubercular therapy regime: A systematic review. Indian journal of ophthalmology. 2023 Mar 1;71(3):729-35.
12 Pai M, Behr MA, Dowdy D, Dheda K, Divangahi M, Boehme CC. Nature reviews disease primers. Tuberculosis. 2016;2:16076.
12 Leonard Jr MK, Blumberg HM. Musculoskeletal tuberculosis. Tuberculosis and Nontuberculous Mycobacterial Infections. 2017 Jun 1:371-92.
13 Ludwig B, Lazarus AA. Musculoskeletal tuberculosis. Disease-a-month: DM. 2007 Jan;53(1):39-45.
14 Nogdallah S, Mustafa ME, Khairy AM, Fatooh M, Abd‐Elmaged HM. Foot and ankle tuberculosis: A case report and review of the literature. Clinical Case Reports. 2023 Jun;11(6):e7483.
15 Dhillon MS, Tuli SM. Osteoarticular tuberculosis of the foot and ankle. Foot & Ankle International. 2001 Aug;22(8):679-86.
16 Conradie F, Diacon AH, Ngubane N, Howell P, Everitt D, Crook AM, Mendel CM, Egizi E, Moreira J, Timm J, McHugh TD. Treatment of highly drug-resistant pulmonary tuberculosis. New England Journal of Medicine. 2020 Mar 5;382(10):893-902.
17 Conradie F, Diacon AH, Ngubane N, Howell P, Everitt D, Crook AM, Mendel CM, Egizi E, Moreira J, Timm J, McHugh TD. Treatment of highly drug-resistant pulmonary tuberculosis. New England Journal of Medicine. 2020 Mar 5;382(10):893-902.
8 Lee N, Nguyen H. Ethambutol. [Updated 2022 Oct 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/ NBK559050/
18 National Centre for Biotechnology Information (2021). Ethambutol, PubChem compound summary for CID 14052.
19 Nagarajan S, Whitaker P. Management of adverse reactions to first-line tuberculosis antibiotics. Current opinion in allergy and clinical immunology. 2018 Aug 1;18(4):333-41.
20 Xiang Y, Ma L, Wu W, Liu W, Li Y, Zhu X, Wang Q, Ma J, Cao M, Wang Q, Yao X. The incidence of liver injury in Uyghur patients treated for TB in Xinjiang Uyghur autonomous region, China, and its association with hepatic enzyme polymorphisms nat2, cyp2e1, gstm1 and gstt1. PloS one. 2014 Jan 23;9(1):e85905
21 Chen SC, Lin MC, Sheu SJ. Incidence and prognostic factor of ethambutol-related optic neuropathy: 10-year experience in southern Taiwan. The Kaohsiung journal of medical sciences. 2015 Jul 1;31(7):358-62.
22 Donald PR, Maher D, Maritz JS, Qazi S. Ethambutol dosage for the treatment of children: literature review and recommendations. The International Journal of Tuberculosis and Lung Disease. 2006 Dec 1;10(12):1318-30.
23 Chamberlain PD, Sadaka A, Berry S, Lee AG. Ethambutol optic neuropathy. Current opinion in ophthalmology. 2017 Nov 1;28(6):545-51.
24 Koul PA. Ocular toxicity with ethambutol therapy: Timely recaution. Lung India: Official Organ of Indian Chest Society. 2015 Jan;32(1):1.
25 Ezer N, Benedetti A, Darvish-Zargar M, Menzies D. Incidence of ethambutol-related visual impairment during treatment of active tuberculosis. The International journal of tuberculosis and lung disease. 2013 Apr 1;17(4):447-55.
26 Kim U, Hwang JM. Early stage ethambutol optic neuropathy: retinal nerve fiber layer and optical coherence tomography. European journal of ophthalmology. 2009 May;19(3):466-9.
27 Chai SJ, Foroozan R. Decreased retinal nerve fibre layer thickness detected by optical coherence tomography in patients with ethambutol-induced optic neuropathy. British journal of ophthalmology. 2007 Jul 1;91(7):895-7.
28 Abbasi Nazari M, Kobarfard F, Tabarsi P, Salamzadeh J. Serum copper (cu) alterations in pulmonary tuberculosis patients under treatment with ethambutol. Biological trace element research. 2009 May;128:161-6.
29 Chen HY, Lai SW, Muo CH, Chen PC, Wang IJ. Ethambutol-induced optic neuropathy: a nationwide population-based study from Taiwan. British journal of ophthalmology. 2012 Nov 1;96(11):1368-71.
30 Azar FM, Canale ST, Beaty JH. Campbell's Operative Orthopaedics, E-Book. Elsevier Health Sciences; 2020 Dec 23.
31 TSAI RK, LEE YH. Reversibility of ethambutol optic neuropathy. Journal of ocular pharmacology and therapeutics. 1997 Oct;13(5):473-7.
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Published
Jun 19, 2024
Article Details
How to Cite
Dr Ravikumar K, Dr L Chendan, Dr Sujatha V, Dr Gurmeet, Dr Kempraj Shivanna, & Dr Pratheeksh Rajanna. (2024). ETHAMBUTOL INDUCED OPTIC NEUROPATHY IN ANKLE TUBERCULOSIS PATIENT- A CASE REPORT. Journal of Population Therapeutics and Clinical Pharmacology, 31(6), 1332-1339. https://doi.org/10.53555/jptcp.v31i6.6514
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Author Biographies
Dr Ravikumar K
Professor of Orthopaedics, MVJMC & RH
Dr L Chendan
Junior Resident of Orthopaedics, MVJMC & RH
Dr Sujatha V
Professor of Orthopaedics, MVJMC & RH
Dr Gurmeet
Junior Resident of Orthopaedics, MVJMC & RH
Dr Kempraj Shivanna
Junior Resident Of Orthopaedics, MVJMC & RH
Dr Pratheeksh Rajanna
Junior Resident of Orthopaedics, MVJMC & RH
How to Cite
Dr Ravikumar K, Dr L Chendan, Dr Sujatha V, Dr Gurmeet, Dr Kempraj Shivanna, & Dr Pratheeksh Rajanna. (2024). ETHAMBUTOL INDUCED OPTIC NEUROPATHY IN ANKLE TUBERCULOSIS PATIENT- A CASE REPORT. Journal of Population Therapeutics and Clinical Pharmacology, 31(6), 1332-1339. https://doi.org/10.53555/jptcp.v31i6.6514