A Challenging Case of TB, Drug Rash with Eosinophilia - Video
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Overview
Tuberculosis is a common infection that presents itself with various manifestations. However, antitubercular drugs (ATDs) are known for their toxicities but still they are the drug of choice. However, it's the drug rash with eosinophilia and systemic symptoms (DRESS) reaction which is a rare toxicity secondary to antitubercular drugs.
Japi describes a rare case of tubercular abscess and the DRESS syndrome; the course of which was further complicated by other adverse drug reactions. A 14-year-old girl presented with fever and low back pain associated with loss of appetite and weight for 1 month. On examination, she had localized tenderness in the right lumbar region. Her tuberculin skin test was strongly positive and ultrasonography revealed a right-sided psoas abscess
She was empirically started on antitubercular drugs which is weight-based isoniazid, rifampicin, pyrazinamide, and ethambutol, from an outside center after which her fever resolved in 2 weeks. Three weeks after initiation of antitubercular drugs, she developed an erythematous skin rash all over the body along with a recurrence of fever. Routine laboratory examination revealed transaminitis and eosinophilia. Her antitubercular drugs s were withheld.
With a diagnosis of DRESS, she was started on high-dose steroids. Tapering of the dosage of steroids was attempted multiple times but was associated with the recurrence of symptoms. Methotrexate was added to the regimen to reduce the dosage of steroids as she was developing steroid-induced hyperglycemia and cushingoid habitus.
Steroids and methotrexate were continued for a total of 3 months. Meanwhile, the abscess was aspirated and the culture was positive for Mycobacterium tuberculosis. Severe complications were seen due to many drugs.
Hematological suppression is a well-known duration-dependent side effect of this drug, which resolves with drug discontinuation, as in this case. Other side effects of long-term linezolid which require monitoring include peripheral neuropathy and optic neuropathy. Also, physicians must be aware of close monitoring of drug interaction including drugs which may precipitate serotonin syndrome along with linezolid.
Researchers concluded that physicians treating tuberculosis must be watchful and wary of drug-related side effects. Early identification and prompt management of these side effects is a requirement to maintain treatment adherence and achieve positive outcomes.
Reference: Parul Kodan1 , Nitin Gupta2 , Himanshu Narang; Cascade of Drug Toxicities: A Challenging Case of Tuberculosis and Drug Rash with Eosinophilia and Systemic Symptoms, volume 70, JAPI,2022.
Speakers
Dr. Nandita Mohan is a practicing pediatric dentist with more than 5 years of clinical work experience. Along with this, she is equally interested in keeping herself up to date about the latest developments in the field of medicine and dentistry which is the driving force for her to be in association with Medical Dialogues. She also has her name attached with many publications; both national and international. She has pursued her BDS from Rajiv Gandhi University of Health Sciences, Bangalore and later went to enter her dream specialty (MDS) in the Department of Pedodontics and Preventive Dentistry from Pt. B.D. Sharma University of Health Sciences. Through all the years of experience, her core interest in learning something new has never stopped. She can be contacted at editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751