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- Title
Antituberculosis-Drugs Induced DRESS: A Multidrug Hypersensitivity or Drug Hypersensitivity Relapse? A Case Report.
- Authors
Mansour, Khadija; Chadli, Zohra; Ben Fadhel, Najah; Ben Fredj, Nadia; Ben Romdhane, Haifa; Chaabane, Amel; Toumi, Adnene; Aouam, Karim
- Abstract
DRESS related to first-line antituberculosis drugs (ATD) is a challenging diagnosis. With a long-lasting combined treatment of 4-concomitantly administrated drugs, identification of the culprit drug remains difficult and may expose patients to treatment interruption and affect their outcome. A 42-year-old female, treated with isoniazid, rifampicin, pyrazinamide and ethambutol for multifocal tuberculosis, developed, 40 days later, hyperthermia, facial edema, cervical lymphadenopathy and generalized exanthema. Biological test results revealed eosinophilia, atypical lymphocytes, and liver injury. DRESS was suspected, and ATD were withdrawn. As patch tests for the 4 ATD showed negative results, we decided to reintroduce pyrazinamide, ethambutol and rifampicin separately with a 3-day interval. Pyrazinamide and rifampicin were tolerated. However, after receiving ethambutol, she developed fever and generalized rash, with no biological abnormalities. Since ethambutol was claimed to be the culprit drug, isoniazid was added, and 10 hours later, the patient developed fever, facial edema, generalized rash, eosinophilia and liver injury. This clinical and biological pattern resolved 2 weeks later. This report suggests a hypersensitivity relapse to ethambutol after isoniazid-induced DRESS.
- Subjects
DRUG therapy for tuberculosis; ETHAMBUTOL; LIVER function tests; GAMMA-glutamyltransferase; CETIRIZINE; ADRENOCORTICAL hormones; FEVER; PYRAZINAMIDE; DRESS syndrome; EXANTHEMA; ISONIAZID; LYMPHATIC diseases; EOSINOPHILIA; LYMPHOCYTES; DISEASE relapse; ANTITUBERCULAR agents; CUTANEOUS therapeutics; RIFAMPIN; BLOOD testing; EDEMA; ALANINE aminotransferase; ASPARTATE aminotransferase
- Publication
Hospital Pharmacy, 2024, Vol 59, Issue 1, p10
- ISSN
0018-5787
- Publication type
Article
- DOI
10.1177/00185787231185870