Tuberc Respir Dis.  2015 Jan;78(1):27-30. 10.4046/trd.2015.78.1.27.

A Case of the Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) Following Isoniazid Treatment

• Lee JY
• Seol YJ
• Shin DW
• Kim DY
• Chun HW
• Kim BY
• Jeong SO
• Lim SH
• Jang AS

• KMID: 2114646
• DOI: http://doi.org/10.4046/trd.2015.78.1.27

Abstract

The drug reaction with eosinophilia and systemic symptom (DRESS) syndrome is a severe adverse drug-induced reaction which includes a severe skin eruption, fever, hematologic abnormalities (eosinophilia or atypical lymphocytes) and internal organ involvement. The most frequently reported drug was anticonvulsants. The diagnosis of DRESS syndrome is challenging because the pattern of cutaneous eruption and the types of organs involved are various. The treatments for DRESS syndrome are culprit drug withdrawal and corticosteroids. Here we report a 71-year-old man with skin eruption with eosinophilia and hepatic and renal involvement that appeared 4 weeks after he had taken anti-tuberculosis drugs (isoniazid, ethambutol, rifampicin, and pyrazinamide), and resolved after stopping anti-tuberculosis drugs and the administration of systemic corticosteroids. DRESS recurred after re-challenging isoniazid, we identified isoniazid was causative drug.

Keyword

DRESS Syndrome; Tuberculosis; Isoniazid

MeSH Terms

Adrenal Cortex Hormones
Aged
Anticonvulsants
Diagnosis
Drug Hypersensitivity Syndrome
Eosinophilia*
Ethambutol
Fever
Humans
Isoniazid*
Rifampin
Skin
Tuberculosis
Adrenal Cortex Hormones
Anticonvulsants
Ethambutol
Isoniazid
Rifampin

Figure

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  Figure 1 Generalized skin eruption and exfoliation showed in whole body on the first day of admission. Leg (A), thigh (B), arm (C), and hand (D).

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  Figure 2 Almost disappeared skin lesion including rash and exfoliation on whole body after stopping all anti-tuberculosis drugs and administration of systemic corticosteroids. Arm (A) and back (B).

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  Figure 3 Recurrence of generalized skin lesion including rash and exfoliation following re-challenging of isoniazid. Arm (A) and back (B).

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