Allergy Asthma Respir Dis.  2015 Jul;3(4):297-301. 10.4168/aard.2015.3.4.297.

Successful readministration of second-line antituberculous agents in a patient with near-fatal drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome

• Moon SD
• Won HK
• Cho JY
• Kang MK
• Kim JY
• Park HK
• Kim S
• Kang HR

• KMID: 2218661
• DOI: http://doi.org/10.4168/aard.2015.3.4.297

Abstract

For the treatment of multidrug-resistant (MDR) tuberculosis, maintenance of appropriate antituberculous agents is essential because of its low cure rate and high dropout rate. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe drug-induced systemic hypersensitivity response resulting in cessation of causative agents. In cases of second-line antituberculous agent-induced DRESS, it is extremely difficult to find other replacement medications to cure MDR tuberculosis. A 53-year-old male who had taken the second-line antituberculous agents (cycloserine, streptomycin, p-aminosalicylic acid, and prothionamide) as well as pyrazinamide for 5 weeks experienced DRESS syndrome accompanying hepatic coma. His symptoms improved with discontinuation of antituberculous agents and administration of high-dose methylprednisolone for 1 month. To resume the antituberculous medication, second-line antituberculous agents were administered one by one using a rapid desensitization protocol. While kanamycin, levofloxacin, and cycloserine were successfully readministered, p-aminosalicylic acid- and prothionamide-induced cutaneous hypersensitivity symptoms were relatively mild compared to previous reactions. Herein, we report a case of successfully treated MDR tuberculosis having a history of fatal DRESS syndrome to antituberculous agents using the rapid desensitization protocol.

Keyword

Drug hypersensitivity syndrome; Antitubercular agents; Immunologic desensitization

MeSH Terms

Aminosalicylic Acid
Antitubercular Agents
Cycloserine
Desensitization, Immunologic
Drug Hypersensitivity Syndrome*
Hepatic Encephalopathy
Humans
Hypersensitivity
Kanamycin
Levofloxacin
Male
Methylprednisolone
Middle Aged
Patient Dropouts
Pyrazinamide
Streptomycin
Tuberculosis
Tuberculosis, Multidrug-Resistant
Aminosalicylic Acid
Antitubercular Agents
Cycloserine
Kanamycin
Methylprednisolone
Pyrazinamide
Streptomycin

Figure

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  Fig. 1 Skin findings of patch test to antitubercular drugs read at 48 hours. Test drugs are isoniazid (INH), levofloxacin (LV), prothinamide (PTH), p-aminosalicylic acid (PAS), streptomycin (SM), ethambutol (ETM), cycloserine (CS), amoxicillin clavulanate (Am), pyrazinamide (Pyz), rifampicin (RFP) in clockwise direction from the right top.

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