Isoniazid‐induced bullous skin reaction

Toxic epidermal necrolysis (TEN) is a potentially life-threatening disorder characterized by widespread erythema, necrosis, and bullous detachment of the epidermis and mucous membranes. Without proper management,TEN can cause sepsis leading to death of the patient. Though TEN is commonly drug induced, Isoniazid (INH) has been uncommonly associated with TEN. As INH is one of the first line drugs in treatment of tuberculosis, TEN induced INH needs modification of antitubercular therapy (ATT) with withdrawal of INH from the treatment regime along with other supportive treatments. Patients with HIV infection and disseminated tuberculosis need to be urgently initiated on an effective ATT on diagnosis of tuberculosis. However, if the patient develops potential life-threatening toxicity to first line antitubercular drugs like INH, an alternative effective ATT combination needs to be started as soon as the condition of the patient stabilizes as most of these patients present in advanced stage of HIV infection and this is to be followed by antiretroviral therapy (ART) as per guidelines. The present case reports the effectiveness of an ATT regime comprising Rifampicin, Pyrazinamide, Ethambutol, and Levofloxacin along with ART in situations where INH cannot be given in disseminated tuberculosis in HIV patients.

show abstract

“…TEN following INH has been reported infrequently in the literature [13]. INH remains a vital component of antitubercular therapy.…”

Section: Discussionmentioning

confidence: 99%

Response to Modified Antitubercular Drug Regime and Antiretroviral Therapy in a Case of HIV Infection with Disseminated Tuberculosis with Isoniazid Induced Toxic Epidermal Necrolysis

Swami

Gupta

Bhattacharjee

2012

Case Reports in Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…Skin hypersensitivity reactions to ethambutol and isoniazid, though possible, are rare, and usually comprise morbilliform and maculopapular rashes, urticaria and pruritus (1–4). Less common are purpura (1,2) (photosensitive) lichenoid reactions (5–7), bullous skin reactions (8), including Stevens–Johnson syndrome (9) and toxic epidermal necrolysis (TEN), acute generalized exanthematous pustulosis (AGEP) (10) and severe exfoliative dermatitis (1,11). Isoniazid has also been reported to cause flushing, pellagra and acneiform eruptions.…”

Section: Discussionmentioning

confidence: 99%

Delayed‐type hypersensitivity reaction to ethambutol and isoniazid

2002

View full text Add to dashboard Cite

Key words: antitubercular agents; drug hypersensitivity; exfoliative dermatitis; positive patch tests; cutaneous adverse drug reactions. Case ReportA 24-year-old woman had recently started antitubercular therapy with isoniazid, ethambutol and rifampicin. This therapy was discontinued 2 weeks later due to an itchy, desquamative, erythematous, papular rash, with painful crusts and excoriations, spreading from the face and hands to the rest of the body. 5 days after withdrawal of all drugs, widespread desquamation and exfoliation with predilection for the body folds and the peri-orbital and peri-oral regions occurred, with swelling of the eyelids and conjunctivitis. Topical fluticasone propionate and oral cetirizine ameliorated the skin condition. The diagnosis of toxicoderma was supported by histology of the skin and an eosinophilia (31%).After the dermatitis had subsided, patch tests were performed with ethambutol, isoniazid and rifampicin (crushed and moistened with water). These were negative at the 1st reading at D2, but positive for both ethambutol and isoniazid at D3, showing erythema and infiltration. Patch tests with ethambutol and isoniazid were negative at D2 and D3 in 10 healthy controls. DiscussionSkin hypersensitivity reactions to ethambutol and isoniazid, though possible, are rare, and usually comprise morbilliform and maculopapular rashes, urticaria and pruritus (1-4). Less common are purpura (1,2) (photosensitive) lichenoid reactions (5-7), bullous skin reactions (8), including Stevens-Johnson syndrome (9) and toxic epidermal necrolysis (TEN), acute generalized exanthematous pustulosis (AGEP) (10) and severe exfoliative dermatitis (1,11). Isoniazid has also been reported to cause flushing, pellagra and acneiform eruptions.Cutaneous reactions in patients on antitubercular therapy are often difficult to diagnose, as several drugs are taken simultaneously. In severe reactions like exfoliative dermatitis oral provocation tests are not recommended. Although epi-and intracutaneous tests are frequently negative, epicutaneous tests can sometimes give valuable information.Cutaneous hypersensitivity to several antitubercular agents in one patient has been described before (12). To our knowledge, this is the 1st patient with a cutaneous reaction to 2 different antitubercular drugs in which the allergic nature was confirmed by positive patch tests to both drugs. These findings indicate that both drugs are directly involved in the skin hypersensitivity reaction, rather than their metabolites. Acknowledgement

show abstract

Isoniazid

2006

Meyler's Side Effects of Drugs: The International Encyclopedia of Adverse Drug Reactions and Interactions

View full text Add to dashboard Cite

Isoniazid‐induced bullous skin reaction

Cited by 10 publications

References 6 publications

Response to Modified Antitubercular Drug Regime and Antiretroviral Therapy in a Case of HIV Infection with Disseminated Tuberculosis with Isoniazid Induced Toxic Epidermal Necrolysis

Response to Modified Antitubercular Drug Regime and Antiretroviral Therapy in a Case of HIV Infection with Disseminated Tuberculosis with Isoniazid Induced Toxic Epidermal Necrolysis

Delayed‐type hypersensitivity reaction to ethambutol and isoniazid

Isoniazid

Contact Info

Product

Resources

About