Allergy Asthma Respir Dis.
2017 Mar;5(2):111-116. 10.4168/aard.2017.5.2.111.
DRESS (drug reaction with eosinophilia and systemic symptom) syndrome caused by both first-line and second-line antitubercular medications: A case report with a brief literature review
- Affiliations
-
- 1School of Medicine, Seoul National University, Seoul, Korea.
- 2Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. helenmed@snu.ac.kr
- 3Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.
- 4Regional Pharmacovigilance Center, Seoul National University Hospital, Seoul, Korea.
- KMID: 2392383
- DOI: http://doi.org/10.4168/aard.2017.5.2.111
Abstract
- Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but potentially fatal drug-induced systemic hypersensitivity response characterized by erythematous eruption, fever, leukocytosis with eosinophilia, and internal organ involvement. Antitubercular agents are potential causative agents for DRESS syndrome but difficult to verify as a culprit drug, since antitubercular agents are coadministered as a combination regimen. A 42-year-old female with endobronchial tuberculosis was diagnosed with DRESS syndrome after 4-week treatment of isoniazid, rifampicin, ethambutol, and pyrazinamide with prednisolone 50 mg. All the antitubercular agents were stopped and replaced with levofloxacin, cycloserine, p-aminosalicylic acid, and kanamycin. However, severe exacerbation of DRESS syndrome compelled the patient to discontinue the administration of the second-line antitubercular agents. Two months later, the patient underwent a patch test for all the antitubercular agents which had been used, and the results showed positivity to isoniazid and cycloserine. We report a rare case of DRESS syndrome that reacted to cycloserine as well as isoniazid. Development of coreactivity to other drugs should be differentiated with a flare-up reaction in the management of DRESS syndrome.
MeSH Terms
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Adult
Aminosalicylic Acid
Antitubercular Agents
Cycloserine
Drug Hypersensitivity Syndrome
Eosinophilia*
Ethambutol
Female
Fever
Humans
Hypersensitivity
Isoniazid
Kanamycin
Leukocytosis
Levofloxacin
Patch Tests
Prednisolone
Pyrazinamide
Rifampin
Tuberculosis
Aminosalicylic Acid
Antitubercular Agents
Cycloserine
Ethambutol
Isoniazid
Kanamycin
Prednisolone
Pyrazinamide
Rifampin
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