Successful readministration of second-line antituberculous agents in a patient with near-fatal drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome.
10.4168/aard.2015.3.4.297
- Author:
Sung Do MOON
1
;
Ha Kyung WON
;
Jae Young CHO
;
Min Koo KANG
;
Ju Young KIM
;
Han Ki PARK
;
Sujeong KIM
;
Hye Ryun KANG
Author Information
1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. helenmed@snu.ac.kr
- Publication Type:Case Report
- Keywords:
Drug hypersensitivity syndrome;
Antitubercular agents;
Immunologic desensitization
- MeSH:
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
- From:Allergy, Asthma & Respiratory Disease
2015;3(4):297-301
- CountryRepublic of Korea
- Language:Korean
-
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.
