A MAN who died after he suffered an adverse drug reaction to medication he was prescribed to treat suspected tuberculosis (TB) had no evidence of TB at autopsy.
Edward Dowdall (64), Johnstown Gardens, Finglas, Dublin, died of liver failure due to drug toxicity at the Mater hospital on January 22nd, 2009.
Coroner Dr Brian Farrell, who recorded a cause of death of liver failure due to drug toxicity secondary to the anti-tuberculosis medications isoniazid and/or rifampicin, said he would be reporting the death to the Irish Medicines Board.
“This is an adverse drug reaction to the medication,” he said.
Dublin City Coroner’s Court heard that Mr Dowdall was admitted to the Mater hospital on December 15th, 2008, complaining of abdominal, back, muscle and chest pains, with associated night sweats, anorexia, nausea and headaches.
He had been commenced on the medication isoniazid, a treatment for TB, three months earlier in September after screening tests for TB (carried out prior to starting a new drug for his arthritis) suggested an active immune reaction to TB. Mr Dowdall had “significant exposure” to TB at the age of 13 when he shared a bedroom with his brother who had TB.
A review of a blood test in October indicated Mr Dowdall’s liver function tests, which had been within the normal range prior to commencing isoniazid, were “deranged”. Isoniazid was stopped and he was commenced on another anti-tuberculosis medication rifampicin (to treat latent TB), which was later discontinued.
Mr Dowdall underwent an extensive number of investigations in hospital following admission in December, including further treatment with anti-tuberculosis medication. The TB medications were discontinued on December 31st.
Mr Dowdall’s condition continued to deteriorate, and he died from complications of liver failure on January 22nd.
There was no evidence of TB at postmortem, while results of mycobacterial cultures, which became available the month after Mr Dowdall’s death, were negative for TB.
Dr Patrick Mallon, consultant in infectious diseases, said Mr Dowdall’s case represents a “diagnostic dilemma”.
“In this case, until the post-mortem report became available, all of the evidence suggested an inflammatory or infective process rather that drug toxicity.”
He said the doctors always had in the back of their minds that the clinical picture could have been influenced by drug toxicity.