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Outcome and Management

  The appearance of liver injury with symptoms and serum aminotransferase levels above 3 times the ULN or any elevation in aminotransferase levels above 5 times the ULN should prompt withdrawal of pyrazinamide. Many cases of pyrazinamide hepatotoxicity are severe and prolonged, and fatal instances have occurred. Pyrazinamide has not been linked to chronic hepatitis or vanishing bile duct syndrome. There is no cross reactivity of the hepatic injury with other currently available antituberculosis agents.