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

Palmero, Domingo; Castagnino, Jorge; Rm, Musella; Mosca, Carlo; P, González Montaner; Casado, de

doi:10.5588/ijtld.12.0441

Cited by 38 publications

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“…These issues mirror our initial concerns about potentially worsening the patient's MAC osteomyelitis. Surprisingly, one case study found no worsening of tuberculosis during prolonged steroid therapy for DRESS syndrome in 11 patients 6. Our case exemplifies the need for multidisciplinary collaboration to provide the appropriate care for patients with DRESS.…”

Section: Discussionmentioning

confidence: 58%

DRESS syndrome presenting after initiation ofmycobacterium aviumcomplex osteomyelitis treatment

et al. 2015

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Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome is characterised by fever, rash, eosinophilia and organ damage that develops 2-6 weeks after the initiation of a medication. We report a case of DRESS syndrome in a 79-year-old man that developed after the introduction of rifabutin, ethambutol and clarithromycin used to treat Mycobacterium avium complex (MAC) vertebral osteomyelitis. This case highlights treatment and management challenges in a patient with known MAC vertebral osteomyelitis requiring prolonged steroids. Steroids are the mainstays of treatment for moderate to severe cases of DRESS syndrome. Initiation of steroids for the treatment of DRESS syndrome among patients with concomitant infections requires multidisciplinary collaboration for optimal management.

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Section: Discussionmentioning

confidence: 58%

DRESS syndrome presenting after initiation ofmycobacterium aviumcomplex osteomyelitis treatment

et al. 2015

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“…[11,12] Our patient developed mild symptoms of drug eruption after initiation of antituberculosis therapy and presented with typical symptoms of DRESS which started 2 weeks after reinitiating of treatment with the same antituberculosis drugs. Therefore, the causative drugs were probably one or more of the 3 antituberculosis drugs (isoniazid, rifampicin, and pyrazinamide).…”

Section: Discussionmentioning

confidence: 99%

Difficult clinical management of antituberculosis DRESS syndrome complicated by MRSA infection

Wang

2017

Medicine

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Rationale:Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe drug-induced hypersensitivity reaction characterized by skin rash, fever, blood abnormalities, and multiple organ involvement. The diagnosis of DRESS syndrome is often delayed because of its variable presentation. Prompt withdrawal of the culprit drug is the definitive treatment. DRESS syndrome induced by antituberculosis drugs has rarely been reported.Patient Concerns:A 50-year-old man admitted to our hospital with recurrent episodes of progressive rash, fever, eosinophilia, lymphadenopathy, hepatic, and pulmonary involvement were experienced after repeat trials of the same antituberculosis drugs.Diagnoses:We diagnosed it as DRESS caused by antituberculosis drugs.Interventions:The case responded well to treatment with systemic corticosteroids and intravenous immunoglobulins. However, repeated bouts of infection with methicillin-resistant Staphylococcus aureus occurred during treatment (clavicular osteomyelitis and knee septic arthritis). He was cured after treatment with linezolid.Outcomes:The patient was discharged on day 112. At 8-month follow-up, there was no relapse of drug eruption and joint swelling.Lessons:Early diagnosis and prompt withdrawal of all suspected drugs is a key tenet of the treatment of DRESS. Our case report highlights the risks inherent in delayed diagnosis of DRESS and the challenges in the clinical management of this condition. Pulmonary manifestations with radiological changes on chest X-ray and CT can be seen in DRESS. These changes need to be differentiated from those caused by pulmonary infections. Clavicular osteomyelitis infected with MRSA may be caused by iatrogenic injury during subclavian vein catheterization. This type of MRSA infections should be treated for 4 to 6 weeks. Blood eosinophilia could be a useful marker of disease progression and treatment response in patients with DRESS. However, more experience and clinical evidence is needed to confirm this.

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“…There are few alternative anti-TB medications, all of which necessitate a longer course of treatment in an already arduous regime with significant potential side effects. Therefore, developing DRESS leads to significant interruptions in TB treatment and a dilemma as to which antituberculous agents can be given next 13 15. It is difficult in the context of antituberculous medication, where four different medications are started together, to ascertain a single offending agent.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, if DRESS had developed due to the combination of antituberculous treatment, reintroduction of any one of the four medications can cause a resurgence of symptoms. In a recent case series, patients’ TB treatment was suspended during the course of DRESS, which was treated with steroids 13. Once the DRESS symptoms had resolved, a new treatment regimen similar to that used for multi-drug resistant TB was initiated slowly 13 15.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent case series, patients’ TB treatment was suspended during the course of DRESS, which was treated with steroids 13. Once the DRESS symptoms had resolved, a new treatment regimen similar to that used for multi-drug resistant TB was initiated slowly 13 15. The most common offending agent was rifampicin, and when restarting antituberculous medication levofloxacin was the best tolerated 13–15…”

Section: Discussionmentioning

confidence: 99%

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Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome secondary to antituberculosis drugs and associated with human herpes virus-7 (HHV-7)

Draz¹,

Datta

Webster

et al. 2013

BMJ Case Reports

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Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a serious reaction to drugs with a clinical presentation of rash, fever, lymph node enlargement and internal organ involvement. Reports have described the reactivation of human herpes virus 6 (HHV-6) and other HHVs in association with this syndrome. We report a 41-year-old woman who developed a rash, fever, liver dysfunction, eosinophilia and atypical monocytosis 21 days after initiation of the quadruple therapy for tuberculous cervical lymphadnitis. HHV-7 DNA was detected in blood by PCR suggesting infection with or more likely reactivation of HHV-7 as a contributing factor or consequence of this serious adverse drug reaction.

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

Cited by 38 publications

References 0 publications

DRESS syndrome presenting after initiation ofmycobacterium aviumcomplex osteomyelitis treatment

DRESS syndrome presenting after initiation ofmycobacterium aviumcomplex osteomyelitis treatment

Difficult clinical management of antituberculosis DRESS syndrome complicated by MRSA infection

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome secondary to antituberculosis drugs and associated with human herpes virus-7 (HHV-7)

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