is druginduced hepatitis related to the severity of tuberculous meningitis background druginduced hepatitis dih occurs more commonly in tuberculous meningitis tbm than noncns tuberculosis we evaluate dih in tbm and its relationship with disease severity and surrogate markers of stressmethods sixtyseven patients with tbm were included prospectively the diagnosis of dih was based on five times elevation of alanine amino transferase alt in asymptomatic and three times in symptomatic patients serum bilirubin 15 mgdl or more occurring after 3 days of antitubercular drugs without any other cause of liver dysfunction and improvement in liver function upon drug withdrawal stage of tbm glasgow coma scale gcs score signs of raised intracranial pressure icp esr creactive protein crp systemic inflammatory response syndrome sirs serum cortisol and mri findings were noted on admission and during dihresults a total of 328 2267 patients with tbm developed dih that was associated with worsening in gcs score p001 stage tbm p002 sirs parameters p004 esr p004 and crp p001 compared with their baseline stage of tbm independently predicted dih or042 95 ci 01810 p004 druginduced hepatitis occurred with paradoxical worsening in 11 patients and had higher mortality 32 vs 7 p001conclusion dih occurred in 328 2267 of patients with tbm and was related to the severity of tbm and possibly to the accompanying physiological stress