Rifampicin Induced Cutaneous Adverse Drug Reaction: A Case Report

Abstract

The treatment of drug-sensitive tuberculosis involves a combination of four drugs, including Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol. Managing adverse skin reactions to these anti-tubercular drugs poses a dilemma, balancing the risk of drug-resistant tuberculosis with the potential worsening of adverse reactions. Adverse reactions, especially skin manifestations, are more prevalent in individuals co-infected with HIV and tuberculosis. An 11-year-old HIV-positive male with Pulmonary Tuberculosis (PTB) presented with vomiting, loose stools, and a high-grade intermittent fever. Having received Anti-Tuberculosis Treatment (ATT) for a week, the patient developed an erythematous rash progressing to hyperpigmented patches, conjunctivitis, and oral lesions. Dermatology diagnosed it as an Exanthematous Drug Eruption, leading to discontinuation of ATT. Rechallenge with ATT drugs identified Rifampicin as the causative agent, resulting in whole-body pruritus. The manifestation of Rifampicin-induced Cutaneous Adverse Drug Reaction (CADR) deviating from conventional patterns highlights the need for individualized approaches. Early detection, careful observation, and judicious management are crucial in preventing adverse outcomes. The case falls under the 'certain' category on the WHO-UMC Causality Assessment scale, emphasizing the importance of vigilant monitoring and prompt intervention in such challenging scenarios.