Difficult clinical management of anti-tuberculosis DRESS syndrome [Case study]

• Published in: The international journal of tuberculosis and lung disease Vol. 17; no. 1; pp. 76 - 78
• Main Authors: Palmero, D., Castagnino, J., Musella, R. M., Mosca, C., González Montaner, P., de Casado, G. C.
• Format: Journal Article
• Language: English
• Published: Paris, France International Union Against Tuberculosis and Lung Disease 01.01.2013; International Union against Tuberculosis and Lung Disease
• Subjects: Adolescent; Adult; Antitubercular Agents - adverse effects; Bacterial diseases; Biological and medical sciences; Chemical and Drug Induced Liver Injury - etiology; Chemical and Drug Induced Liver Injury - therapy; Corticoids; Drug Eruptions - etiology; Drug Eruptions - therapy; Drug toxicity and drugs side effects treatment; Eosinophilia; Eosinophilia - chemically induced; Eosinophilia - therapy; Exanthema - chemically induced; Exanthema - therapy; Female; Hematologic and hematopoietic diseases; Human bacterial diseases; Humans; Hypersensitivity; Infectious diseases; Male; Medical sciences; Miscellaneous (drug allergy, mutagens, teratogens...); Mycobacterium; Other diseases. Hematologic involvement in other diseases; Pharmacology. Drug treatments; Pneumology; Rash; Retrospective Studies; rifampicin; Syndrome; Tuberculosis; Tuberculosis and atypical mycobacterial infections; Young Adult; Allergy; Immunopathology; Skin disease; Hypersensitivity; Hemopathy; Mycobacterial infection; Eosinophilia; Infection; DRESS syndrome; rash; Antibiotic; Clinical management; Rifampicin; Tuberculosis; Bacteriosis; Antituberculous agent; Antibacterial agent; Pneumology
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.12.0441

We describe 11 cases of anti-tuberculosis DRESS (drug-related rash with eosinophilia and systemic symptoms) syndrome, a potentially serious complication of treatment that led to interruption of treatment for prolonged periods, systemic corticosteroid use and the resumption of treatment with less effective regimens. All patients had rash and toxic hepatitis, one died of multi-organ failure and, contrary to expectations, the evolution of tuberculosis (advanced in most cases) did not progress under corticosteroid treatment. The drug most frequently involved was rifampicin, while retreatment schemes included, in most cases, levofloxacin, ethambutol, streptomycin and cycloserine.