Severe cutaneous adverse drug reactions due to antituberculosis drugs and their management.
Metin Keren, Aysun Aynaci, Ismet Bulut, Neslihan Cerrah Demir, Aylin Babalik, Ali Selcuk
Northern clinics of Istanbul · 2025-01
Abstract
OBJECTIVE: Tuberculosis and drug reactions due to antituberculosis drugs are important public health problems. Severe cutaneous adverse drug reactions (SCARs) due to antituberculosis drugs are factor that makes tuberculosis treatment difficultchallenging. In this real-life study, we present our experience with SCARs due to antituberculosis drugs and their management.
METHODS: Patients hospitalized in the tuberculosis ward of tertiary care reference hospital between January 1, 2015, and September 1, 2023, were retrospectively reviewed. Patients who consulted the immunology and allergy clinic were included in the study.
RESULTS: A total of 4,039 patients were hospitalized with tuberculosis during the study period. A total of 316 (7.8%) patients were consulted, and out of these, eight (2.5%) patients were evaluated as SCARs. Of the eight patients, seven (87.5%) were diagnosed with drug reaction with eosinophilia and systemic symptoms (DRESS), and one was diagnosed with Stevens-Johnson syndrome (SJS) (12.5%). The peripheral blood eosinophil count of patients with DRESS ranged between 740 and 8,690 cells/µL. One patient tested positive for human immunodeficiency virus and developed SJS. Methylprednisolone intravenous 1 mg/kg and Fexofenadine 180 mg/day per oral were used in the treatment of SCARs in all cases. Ad-on treatment for three cases used mepolizumab (anti-IL5 monoclonal antibody) for DRESS. All patients were switched to an alternative treatment protocol and tolerated the new regimen well.
CONCLUSION: In cases with developed SCARs, a new treatment protocol consisting of different medications can be applied after the symptoms improve. DRESS was the most common SCAR of antituberculosis drugs. Monitoring the eosinophil count can help in early diagnosis. Systemic steroids and antihistamines may be effective in the treatment. Mepolizumab can be used with off-label approval in the treatment of DRESS cases to accelerate the treatment process.