DRESS syndrome and acute generalized exanthematous pustulosis induced by antituberculosis medications and moxifloxacin: case report

• Published in: International journal of clinical pharmacology and therapeutics Vol. 54; no. 10; pp. 808 - 815
• Main Authors: Kim, Hyunah, Bang, Eun Sook, Lim, Seung-Kwan, Lee, Jae Myeong
• Format: Journal Article
• Language: English
• Published: Germany Dustri - Verlag Dr. Karl Feistle GmbH & Co. KG 01.10.2016
• Subjects: Acute Generalized Exanthematous Pustulosis - etiology; Acute Generalized Exanthematous Pustulosis - pathology; Adult; Allergies; Antibiotics; Antitubercular Agents - administration & dosage; Antitubercular Agents - adverse effects; Case reports; Disease Progression; Drug Hypersensitivity Syndrome - etiology; Drug Hypersensitivity Syndrome - pathology; Eosinophils - metabolism; Female; Fluoroquinolones - administration & dosage; Fluoroquinolones - adverse effects; Humans; Pruritus - etiology; Side effects; Skin
• ISSN: 0946-1965
• DOI: 10.5414/CP202595

To report a rare case of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome caused by antituberculosis (TB) drugs, which progressed to acute generalized exanthematous pustulosis (AGEP) after moxifloxacin treatment. A 25-year-old female was hospitalized for dyspnea and dizziness. She had a history of TB and experienced rifampin-induced skin rash. She was treated for TB with moxifloxacin, isoniazid, ethambutol, and pyrazinamide. Upon admission, she had a fever of 39.2 °C, and aspartate aminotransferase (AST), alanine aminotransferase (ALT) levels, and eosinophil count increased during the first 10 days after admission. The patient had a rash all over the body with itching, pain, and a burning sensation. Diagnosis of DRESS syndrome was made. Immunoglobulin and prednisolone administration improved the DRESS symptoms. After the first DRESS syndrome diagnosis, anti-TB medications were changed to isoniazid, ethambutol, pyrazinamide, cycloserine, and streptomycin, which also caused a skin rash, itching, and elevated AST/ALT levels, and eosinophil count. Then, the anti-TB treatment was changed to cycloserine, streptomycin, ethionamide, and para-aminosalicylic acid. The rash and itching persisted and eosinophil count increased further. All TB medications were discontinued except streptomycin. Due to the flushing and a burning sensation by streptomycin at the injection site, it was replaced with moxifloxacin. The patient experienced erythematous pustules and patches on skin with desquamation, fissures, and swelling. Therefore, a diagnosis of moxifloxacin-induced AGEP was made. DRESS syndrome induced by anti-TB drugs developed in a 25-year-old woman with moxifloxacin-related subsequent AGEP.
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