Which of the following is a major adverse effect of pyrazinamide aside from hepatotoxicity?

• A. Hypouricemia
• B. Hypoglycemia
• C. Hypokalemia
• D. Hyperuricemia and gout

Answer: (D)

This question targets adverse effects of pyrazinamide beyond liver toxicity. Pyrazinamide commonly raises uric acid levels by reducing renal excretion of urate (sometimes increasing production as well), which can lead to hyperuricemia and gout attacks. This makes hyperuricemia and gout the best answer, since other options describe conditions not typically caused by pyrazinamide (low uric acid, low blood sugar, or low potassium). In practice, monitor uric acid levels and watch for gout symptoms in patients receiving pyrazinamide, especially those with a history of gout or elevated baseline urate.