Indian Journal of Pharmacy Practice, Vol 15, Issue 1, Jan-Mar, 2022 49 Case Report www.ijopp.org DOI: 10.5530/ijopp.15.1.10 Address for correspondence: Dr. Sathiyanarayanan L, Associate Professor, Depart- ment of Pharmaceutical Chemistry, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be) University, Pune-411046, Maharashtra State, INDIA. Email id: l.satyanarayan@ bharatividyapeeth.edu Pyrazinamide-induced Polyarthralgia and Myalgia in a Case of Stable Chronic Kidney Disease Bijoy Kumar Panda 1 , Vaibhav Rajendra Suryawanshi 1 , Medha Bargaje 2 , Sathiyanarayanan L 3, * 1 Department of Clinical Pharmacy, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Erandwane, Pune, Maharashtra, INDIA. 2 Department of Pulmonary Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Pune, Maharashtra, INDIA. 3 Department of Pharmaceutical Chemistry, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Erandwane, Pune, Maharashtra, INDIA. ABSTRACT Pyrazinamide is known to cause hyperuricemia and is followed by gout arthritis. But the fate of this drug in chronic kidney disease (CKD) patients is still not explored in details yet. We report a case of a 65-year-old Asian-Indian woman who was diagnosed with stable CKD 5 years ago and is currently diagnosed with peritoneal tuberculosis with pleural effusion. She was started on antitubercular therapy (ATT). On the 11th day of ATT, she developed a rise in uric acid (from 7.2 mg/dL to 13.1 mg/dL) and creatine kinase levels (from 156 U/L to 887 U/L), followed by polyarthralgia and generalised myalgia on investigation. Her elevated uric acid and creatine kinase levels and polyarthralgia improved on cessation of pyrazinamide, but improvement in her myalgia and muscle weakness was postponed. Pyrazinamide plasma 2 hr levels post dose was performed suspecting polyarthralgia and myalgia as an adverse drug reaction and estimated to be 59 µg/ml (normal range: 20-50 µg/ml). Subjective and objective assessments along with pyrazinamide plasma levels may be an indicative evidence of the adverse reaction as the estimated plasma concentration at 2 hr was higher than the normal range. Key words: Pyrazinamide, Polyarthralgia, Myalgia, Stable chronic kidney disease, Plasma levels. BACKGROUND Renal impaired patients did not show any significant differences in pharmacokinetics of pyrazinamide and pyrazinoic acid compared to normal patients, however higher levels and reduced metabolism of pyrazinamide was observed in patients with renal failure. This is due to accumulation or delayed elimination of pyrazinamide. 1,2 Dosage adjustments and therapeutic drug monitoring (TDM) found to be useful in such patients, where monitoring of plasma concentration for 2 to 6 hr after administration has been recommended. 3,4 We present a case of pyrazinamide-induced polyarthralgia and myalgia in a stable chronic kidney disease (CKD) patient, where plasma levels of pyrazinamide were estimated. CASE PRESENTATION A 65-year-old Asian-Indian woman weighing 45-kgs with a known case of ischemic heart disease and stable chronic kidney disease for over 5 years presented to Pulmonary Medicine OPD of Bharati Hospital and Research Center, Pune with complaints of abdominal pain (periumbilical region), breathlessness, and reduced appetite since 15-days, weight loss (10-15 kg since 2-3 months). She had no history of fever, cough, cold or sore throat. She had a temperature of 38.2°C with a sinus pulse of 96/min