Recurrent acute pancreatitis after isoniazid

Drug-induced acute pancreatitis should be in the differential diagnosis of acute abdomen occurring soon after initiation of tuberculosis treatment and chemoprophylaxis. Isoniazid-induced pancreatitis is potentially reversible; early recognition and drug withdrawal are warranted in the appropriate clinical setting. We present a case of reversible acute pancreatitis after isoniazid treatment of genitourinary tuberculosis, followed by recurrence of pancreatitis 12 years later when the patient received isoniazid again for pulmonary tuberculosis. Isoniazid-induced pancreatitis, if highly suspicious or confirmed with re-challenge test, mandates permanent avoidance of the drug.