Spectrum of cutaneous adverse drug reactions to anti-tubercular drugs and safe therapy after re-challenge - A retrospective study

Sharma, Reena; Verma, Ghanshyam; Tegta, Geeta Ram; Sood, Shilpa; Rattan, Renu; Gupta, Mrinal

doi:10.4103/idoj.idoj_133_19

Cited by 20 publications

(23 citation statements)

References 17 publications

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“…Other culprit drugs are listed in Table S1. Regarding anti‐infectious treatments (tetracyclines, ß‐lactam antibiotics, sulfonamides or anti‐tubercular drugs) were a reported cause of LDE in 17 (5.3%) cases 63–70 antiviral agents for hepatitis treatment were associated with LDE in 7 (2.2%) cases 71–76 and the antimycotic drug terbinafine in three cases (0.9%) 77–81 …”

Section: Resultsmentioning

confidence: 99%

“…Other culprit drugs are listed in Table S1. Regarding anti-infectious treatments (tetracyclines, ß-lactam antibiotics, sulfonamides or anti-tubercular drugs) were a reported cause of LDE in 17 (5.3%) cases [63][64][65][66][67][68][69][70] antiviral agents for hepatitis treatment were associated with LDE in 7 (2.2%) cases [71][72][73][74][75][76] and the antimycotic drug terbinafine in three cases (0.9%). [77][78][79][80][81] Furthermore, we identified six cases (1.9%) of LDE caused by beta-blockers 77,[82][83][84][85][86] and 7 (2.2%) cases caused by statins.…”

Section: Culprit Medicationsmentioning

confidence: 99%

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Cutaneous lichenoid drug eruptions: A narrative review evaluating demographics, clinical features and culprit medications

Maul

Guillet

Oschmann

et al. 2023

Acad Dermatol Venereol

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Cutaneous lichenoid drug eruptions (LDE) are adverse drug reactions (ADR) characterized by symmetric, erythematous, violaceous papules reminiscent but rarely fully characteristic of lichen planus (LP). We aimed to analyse the literature describing cases of LDE within the last 20 years to provide additional insight into culprit drugs, typical latency to onset of the eruption, the spectrum of clinical presentations, severity and management. A literature search was conducted in MEDLINE between January 2000 and 27 January 2021. The keywords ‘lichenoid drug rash’ and ‘lichenoid drug eruption’ were used. Cases were included if LDE diagnosis was made, and culprit drugs were identified. A total of 323 cases with LDE were identified from 163 published case reports and studies. The mean patient age was 58.5 years (1 month to 92 years), and 135 patients (41.8%) were female. Checkpoint inhibitors (CKI) were the most frequently reported culprit drugs (136 cases; 42.1%), followed by tyrosine kinase inhibitors (TKI) (39 cases; 12.0%) and anti‐TNF‐α‐monoclonal antibodies (13 cases; 4.0%). The latency between initiation of the drug and manifestation was 15.7 weeks (range: 0.1–208 weeks). After discontinuing the culprit drug, the median time to resolution was 14.2 weeks (range: 0.71–416 weeks). One hundred thirty‐six patients (42.1%) were treated with topical, and 54 patients (16.7%) with systemic glucocorticoids. Overall, we conclude that, albeit rare, LDE is challenging to diagnose ADR induced by mostly CKI, TKI, and biologics. Treatment modalities resemble that of lichen planus, and the culprit drugs had to be discontinued in only 26%, which is low compared with other types of adverse drug reactions. This is probably due to the low risk of aggravation (e.g. toxic epidermal necrolysis) if the drug is continued and the benefit/risk ratio favouring the drug, as is often the case in cancer therapy.

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Section: Resultsmentioning

confidence: 99%

Section: Culprit Medicationsmentioning

confidence: 99%

Cutaneous lichenoid drug eruptions: A narrative review evaluating demographics, clinical features and culprit medications

Maul

Guillet

Oschmann

et al. 2023

Acad Dermatol Venereol

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“…The latent period of appearance of rash after intake of the drug varied between 3 days to 150 days with the mean duration being 33 days [10]. A better watch should be kept on any reactions that develop and should be well taken care of by the doctor.…”

Section: Discussionmentioning

confidence: 99%

Stevens - Johnson syndrome After Anti-Tubercular Therapy in a Patient with Tuberculosis of the Spine

Shah¹

2023

J Critical Care & Emerg Med

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This case is of a 54-year-old female showing a rare and life-threatening steven johnson syndrome (Toxic epidermal necrolysis) as an adverse reaction after starting with Anti-tubercular therapy for tuberculosis of the spine (D8-D9). The patient developed a cutaneous reaction 10 days after starting treatment for Tuberculosis. The documentation of Steven Johnson syndrome after starting anti-tubercular drugs is sparse and Tuberculosis is a high-incidence and prevalence disease, the drugs used to treat the same are widely used.

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“…5 The most frequently observed CADR with the treatment is a maculopapular rash, followed by other types like urticarial, lichenoid, drug rash with eosinophilia and systemic symptoms (DRESS), acute generalized exanthematous pustulosis (AGEP), and exfoliative dermatitis. 5 Our patient was undergoing first-line drug therapy when he developed a pruritic rash with multiple bullous formations and vesicular lesions on his left hand, both on the palmar and dorsal aspects. Suspecting an allergic reaction, the response was managed with antihistamines, intravenous fluid, electrolyte supplementation, and discontinuation of the anti-TB regimen.…”

Section: Discussionmentioning

confidence: 99%

“…While most patients develop a rash within 2months of treatment, our patient experienced CADRs within 3days of starting treatment. 5 The most frequently observed CADR with the treatment is a maculopapular rash, followed by other types like urticarial, lichenoid, drug rash with eosinophilia and systemic symptoms (DRESS), acute generalized exanthematous pustulosis (AGEP), and exfoliative dermatitis. 5…”

Section: Discussionmentioning

confidence: 99%

Cutaneous drug reaction secondary to antitubercular regimen: A case report from Nepal

Bhattarai,

Yadav,

Sapkota

et al. 2023

SAGE Open Medical Case Reports

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Cutaneous adverse drug reactions are known side effects of first-line antitubercular therapy, which ranges from mild pruritus to life-threatening toxic epidermal necrolysis. Severe cutaneous adverse drug reactions can lead to antitubercular therapy discontinuation and further complicates tuberculosis treatment. Here we present the case of a 49-year-old obese male who developed a generalized maculopapular rash within 24 hours of initiation of therapy followed by bullae over palms in 3 days. Antitubercular therapy was immediately discontinued, and he was managed with antihistamines, intravenous fluid, and electrolyte supplementation. He was discharged on antihistamines, a short course of systemic steroids, moxifloxacin, and bedaquiline (second-line antitubercular therapy (ATT)). Proper guidelines about rechallenge therapy will enormously aid in managing cutaneous adverse drug reactions, and efficient treatment of tuberculosis in these patients, and ceasing its progression to multisystemic complications. This article aims to discuss the presentation and management of cutaneous adverse drug reactions in the setting of Nepal.

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Spectrum of cutaneous adverse drug reactions to anti-tubercular drugs and safe therapy after re-challenge - A retrospective study

Cited by 20 publications

References 17 publications

Cutaneous lichenoid drug eruptions: A narrative review evaluating demographics, clinical features and culprit medications

Cutaneous lichenoid drug eruptions: A narrative review evaluating demographics, clinical features and culprit medications

Stevens - Johnson syndrome After Anti-Tubercular Therapy in a Patient with Tuberculosis of the Spine

Cutaneous drug reaction secondary to antitubercular regimen: A case report from Nepal

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