Isoniazid-Induced Acute Psychosis in a Patient with Pleural Tuberculosis

Tuberculosis is one of the top 10 causes of death and the leading cause from a single infectious agent (above HIV/AIDS). Isoniazid is highly bactericidal against replicating tubercle bacilli and is a component of all antituberculous chemotherapeutic regimens currently recommended by the World Health Organization (WHO). Several neuropsychiatric adverse effects, following both therapeutic and overdose use of isoniazid, have been described and isoniazid-induced psychosis, although uncommon, has been reported in the literature. We describe the case of a 21-year-old black woman, with no prior psychiatric history, who developed a psychotic episode four days after she was started on isoniazid. This case highlights psychosis arising as a possible adverse effect of isoniazid and the importance of remaining vigilant when antituberculous therapy is started.