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.
10.4168/aard.2017.5.2.111
- Author:
Young Hoon HWANG
1
;
Dong Yeon JANG
;
Sung Yoon KANG
;
Kyung Hee SOHN
;
Dong Yoon KANG
;
Chang Hoon LEE
;
Hye Ryun KANG
Author Information
1. School of Medicine, Seoul National University, Seoul, Korea.
- Publication Type:Case Report
- Keywords:
Drug hypersensitivity syndrome;
Antitubercular agents;
Patch tests
- MeSH:
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
- From:Allergy, Asthma & Respiratory Disease
2017;5(2):111-116
- CountryRepublic of Korea
- Language:Korean
-
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.
