Ethambutol and pyrazinamide-induced toxic epidermal necrolysis in an immunocompetent adult with tuberculosis

Das, Suman; Jana, Pulak Kumar; Bandyopadhyay, Arun; Biswas, Indranil

doi:10.4103/0970-2113.92376

Cited by 3 publications

(6 citation statements)

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“…For each of these drugs, a high probability of causality was assigned due to their potential high risk documented in the literature. 29–59 Furthermore, their median TTO of symptoms was 8 days with a range of 1–28 days, matching other studies. 18,25 This is consistent with the latency period for the T-lymphocyte-mediated type IV hypersensitivity reaction notable for causing SJS and TEN.…”

Section: Discussionsupporting

confidence: 80%

“…7,9,29–58 Given the idiosyncratic nature of SJS and TEN, and the wide range of drugs previously implicated in their causalities, we sought for evidence documenting the causality between the suspect drug or concomitant drug and SJS or TEN through an extensive literature search. 29–58 The evidence is classified as excellent (existence of the causality is clearly established by randomized controlled trial studies), good (reports in the literature strongly suggests that the causality exists, but not supported by well-controlled studies), fair (the causality is scarcely documented in the literature; however, SJS or TEN is suspected based on some pharmacologic considerations of the suspect drugs), poor (only few studies and limited reported cases support the existence of the causality), or unlikely (insufficient documentation of the c...…”

Section: Methodsmentioning

confidence: 99%

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Severe cutaneous adverse drug reactions manifesting as Stevens-Johnson syndrome and toxic epidermal necrolysis reported to the national pharmacovigilance center in Nigeria: a database review from 2004 to 2017

Oshikoya

Ogunyinka

Ogar

et al. 2020

Therapeutic Advances in Drug Safety

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Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions (SCARs). There is scant literature on the characteristics and causes of these conditions among the Nigerian population. Here, we describe the epidemiology, associated morbidity and mortality, and culpable drugs in SJS and TEN cases using the National Pharmacovigilance (NPC) database in Nigeria. Methods: A retrospective review of the NPC database was done to analyze SJS and TEN cases reported over a period of 14 years. Annual reports, age and sex of patients, type of reporter, suspects and concomitant drugs, time to onset (TTO) of the reactions, and outcome of SJS and TEN were evaluated. Results: The NPC received a total of 24,015 adverse drug reaction (ADR) reports. SJS and TEN accounted for 284 (0.1%) of the total reports, of which 254 (89.4%) were SJS and the remainder were TEN. Females ( n = 184, 64.8%) and individuals aged 19–40 years ( n = 181, 63.7%) were the most affected by SJS and TEN. Antiretrovirals, followed by antibiotics, were the most common drug classes reported to cause SJS and TEN, with nevirapine ( n = 174, 40.7%) and co-trimoxazole ( n = 143, 33.5%) being the most widely implicated drugs. Among patients with reported outcomes, 73 (28.7%) SJS and 3 (10.0%) TEN cases recovered without sequelae, at the time of reporting. Severity of the SCAR was reported for only 171 (69.0%) cases, of which 12 (4.7%) and 8 (26.7%) resulted in death (Grade 5) among SJS and TEN cases, respectively. Conclusions: Antiretroviral and antibiotics were the commonly reported offending group of drugs for SJS and TEN cases. Nevirapine and co-trimoxazole were the commonly reported suspect drugs. SJS and TEN were reported most frequently in females and in patients aged 19–40 years, indicating that drug surveillance and counseling in these groups of patients may be beneficial.

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Section: Discussionsupporting

confidence: 80%

Section: Methodsmentioning

confidence: 99%

Severe cutaneous adverse drug reactions manifesting as Stevens-Johnson syndrome and toxic epidermal necrolysis reported to the national pharmacovigilance center in Nigeria: a database review from 2004 to 2017

Oshikoya

Ogunyinka

Ogar

et al. 2020

Therapeutic Advances in Drug Safety

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“… 12 TEN symptoms usually appear between 6 days to 14 days after taking antituberculosis therapy in tuberculosis patients. 13 , 14 Das et al reported a TEN case in an immunocompetent adult with tuberculosis, however, the patient was elderly (67-years-old). 13 The longest duration between drug administration and TEN symptoms presentation was five weeks.…”

Section: Discussionmentioning

confidence: 99%

Case Report: A successful case of toxic epidermal necrolysis treated with plasmapheresis therapy

et al. 2022

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Toxic epidermal necrosis (TEN) is rare and can be life-threatening for patients. Appropriate management of TEN patients could give optimal results and prevent complications. One treatment modality for TEN is plasmapheresis, which is rarely available in most cases with severe TEN. Here we reported a successful treatment of severe TEN with plasmapheresis. A 40-year-old woman under tuberculosis therapy complained of shortness of breath that began four days prior to hospital admission and worsened ever since. The patient's skin was peeling with red spots and rashes all over the body for a week. During the examination, the patient was compos mentis, and the SCORTEN score was 2 with 12.1% risk of mortality rate. Dermatological examination of the face, trunk and extremities found extensive erosions, loose bullae filled with clear fluid, brown crusts, and generalized distribution with more than 30% epidermolysis. The patient was diagnosed with toxic epidermal necrolysis caused by antituberculosis therapy. We treated the patient by discontinuing the suspected drugs and administering the corticosteroids, but no improvement was observed. The patient underwent two cycle plasmaphereses with 5% albumin, resulting in 1.2 liter of plasma exchange. Re-epithelialization was observed after three days, and the patient was discharged on day 8. This case-report highlights the important role of plasmapheresis in treating the TEN patients. However, a study with larger sample sizes is warranted to validate the efficacy of plasmapheresis in TEN.

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“…Therefore, in our patient, we waited until the confirmation of TB infection was made through culture to start ATT. There are case reports and is a cohort study carried out by Chulalongkorn University of Bangkok, Thailand, where it describes that ATT should be introduced individually with gradual desensitization to recognize the responsible drug for SJS [8–10]. This method was followed with this patient, first starting the second-line anti-TB drugs with gradual desensitization and introducing typical ATT drugs with least possible drug to develop SJS.…”

Section: Discussionmentioning

confidence: 99%

“…Almost all ATT can cause Stevens–Johnson syndrome (SJS) as an adverse effect [7, 8]. If it occurs, introducing ATT in a staged fashion with combination of first- and second-line drugs is recommended [8–10].…”

Section: Introductionmentioning

confidence: 99%

Empyema Necessitans due to Interruption of Antituberculosis Treatment

Benaragama

Pushpakumara

Wanigasuriya

2019

Case Reports in Infectious Diseases

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Empyema necessitans is a rare presentation of tuberculous infection, commonly encountered in immunocompromised patients. The diagnosis can be challenging due to the paucibacillary nature of the condition and nonspecific symptoms. Identifying the organism in culture is the gold standard method of diagnosis. We describe a patient with chronic kidney disease, who developed empyema necessitans due to interruption of antituberculous therapy. Initially, he was started on antituberculous therapy based on a clinical diagnosis of smear-negative pulmonary tuberculous infection; this resulted in Stevens–Johnson syndrome needing a long course of steroid therapy. He later presented with a painful chest lump and was diagnosed as empyema necessitans. Finding the etiology for this rare presentation lead to a diagnostic dilemma, finally confirming the TB infection from the culture. This case highlights the importance of being aware of unusual complications of tuberculous infection in immunocompromised settings.

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Ethambutol and pyrazinamide-induced toxic epidermal necrolysis in an immunocompetent adult with tuberculosis

Cited by 3 publications

References 4 publications

Severe cutaneous adverse drug reactions manifesting as Stevens-Johnson syndrome and toxic epidermal necrolysis reported to the national pharmacovigilance center in Nigeria: a database review from 2004 to 2017

Severe cutaneous adverse drug reactions manifesting as Stevens-Johnson syndrome and toxic epidermal necrolysis reported to the national pharmacovigilance center in Nigeria: a database review from 2004 to 2017

Case Report: A successful case of toxic epidermal necrolysis treated with plasmapheresis therapy

Empyema Necessitans due to Interruption of Antituberculosis Treatment

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