ABSTRACT
Drug-induced muscle disorders are now well known and vary from a simple isolated increase in muscle enzymes to severe drug-induced myopathy. The list of drugs inducing myopathy is very long and continues to grow. The onset of muscle disorders under isoniazid often falls within a drug-induced neuropathy or a drug-induced lupus. However, the occurrence of isolated isoniazid-induced drug myopathy without neuropathy is an extremely rare condition especially with non-toxic doses. The authors report the case of a 28-year-old man, without a previous medical history, hospitalized for pulmonary tuberculosis. After initiating tuberculosis treatment for five days, he presented muscle pain, fasciculation and weakness initially involving the lower left limb that quickly propagated to all four limbs. The physical examination noted a left ankle flush, a swollen left calf and fasciculation of both calves while the neurological examination was normal. The CPK was normal. Electromyography confirmed the myopathy without neuropathic findings. Isoniazid withdrawal was marked by the rapid disappearance of the symptoms. The reintroduction of a half-dose of isoniazid only induced a few transitional muscular fasciculations. The onset of the symptoms under tuberculosis treatment, the absence of later muscle disorders, the absence of any other cause of myopathy and the total disappearance of the symptoms after isoniazid withdrawal confirmed the diagnosis of isoniazid-induced myopathy.
Subject(s)
Isoniazid/adverse effects , Muscular Diseases/chemically induced , Adult , Antitubercular Agents/adverse effects , Humans , Male , Muscular Diseases/diagnosis , Muscular Diseases/diagnostic imaging , Radiography, ThoracicABSTRACT
BACKGROUND: In thoracic oncology, no tumor marker has yet shown sufficient sensitivity nor specificity to be usefull for lung cancer diagnosis. However, in some cases, monitoring of tumor marker blood levels provides useful evaluation of response to specific treatment and assessment of infracfinical tumor progression. AIM: To determine the value of umor markers in pulmonary tuberculosis. METHODS: A prospective study was conducted in our department during 2 years 2005 through 2007. We included 40 men who presented confirmed pulmonary tuberculosis. Before starting antituberculous chemotherapy, serum assays were practiced for the following tumor markers: NSE, CA125, ACE and Cyfra 21.1. RESULTS: Mean age was 37.12 years (17-81). The levels of NSE were high in 91.66% of cases with an average value of 29.22 microg/l (2.24 X normal). This highest sensitivity was superior to those of other tumor markers: 55.55% for CA125, 28.94% for ACE and 7.6% for Cyfra 21.1. Analysis of the levels of NSE according to age, tobacco consumption, delay of consultation, type of the pulmonary lesions and negativation delay in smear did not show any significant difference, whereas levels of CA125 were higher in bilateral lesions (P = 0.05). CONCLUSION: The highest sensitivity of the NSE in pulmonary tuberculosis, with no neoplastic pathology could be interesting for diagnosis of smear negative tuberculosis, with small amounts of bacilli.
