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DRESS syndrome due to first-line antitubercular therapy – A diagnostic imbroglio!

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome after the use of first-line antitubercular drugs (ATDs) is rare and literature regarding DRESS syndrome due to ATDs is scarce in children. We report a young boy with tuberculosis who developed DRESS syndrome after exposure to iso...

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Autores principales: Patra, Pratap K., Banday, Aaqib Z., Jindal, Ankur K., Bhattarai, Dharmagat, Patra, Nilamani, Saikia, Uma N., Gupta, Anju, Suri, Deepti
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9480812/
https://www.ncbi.nlm.nih.gov/pubmed/36119243
http://dx.doi.org/10.4103/jfmpc.jfmpc_1031_21
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author Patra, Pratap K.
Banday, Aaqib Z.
Jindal, Ankur K.
Bhattarai, Dharmagat
Patra, Nilamani
Saikia, Uma N.
Gupta, Anju
Suri, Deepti
author_facet Patra, Pratap K.
Banday, Aaqib Z.
Jindal, Ankur K.
Bhattarai, Dharmagat
Patra, Nilamani
Saikia, Uma N.
Gupta, Anju
Suri, Deepti
author_sort Patra, Pratap K.
collection PubMed
description Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome after the use of first-line antitubercular drugs (ATDs) is rare and literature regarding DRESS syndrome due to ATDs is scarce in children. We report a young boy with tuberculosis who developed DRESS syndrome after exposure to isoniazid. A 9-year-old boy, diagnosed clinically as pulmonary tuberculosis, presented with fever, fast breathing, maculopapular rash, and one episode of gross hematuria. He had been on 4-drug ATD therapy (isoniazid, rifampicin, ethambutol, and pyrazinamide) for the past 4 weeks. In view of multiorgan involvement and absence of a microbiological diagnosis of tuberculosis, vasculitis was considered and he was treated with steroids. As the child recovered, both corticosteroids and ATD therapy were stopped. At 6 months of follow-up, he was presented with pneumonia. Microbiological diagnosis of tuberculosis was made and 4-drug ATD therapy was reinitiated. After 15 days, he again developed a high-grade fever and rash. On evaluation, isoniazid-induced DRESS syndrome was diagnosed. Subsequently, he received a modified regimen of ethambutol, pyrazinamide, levofloxacin, and linezolid. DRESS syndrome did not recur on these ATDs and the child became asymptomatic. Linezolid was stopped after 3 months of therapy and ethambutol, pyrazinamide, and levofloxacin are being continued. Currently, he has completed 15 months of modified ATD therapy. As a high index of suspicion is required for early diagnosis and management that are crucial to reducing morbidity and mortality, DRESS syndrome should be among the differentials in children with unexplained febrile illnesses.
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spelling pubmed-94808122022-09-17 DRESS syndrome due to first-line antitubercular therapy – A diagnostic imbroglio! Patra, Pratap K. Banday, Aaqib Z. Jindal, Ankur K. Bhattarai, Dharmagat Patra, Nilamani Saikia, Uma N. Gupta, Anju Suri, Deepti J Family Med Prim Care Case Report Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome after the use of first-line antitubercular drugs (ATDs) is rare and literature regarding DRESS syndrome due to ATDs is scarce in children. We report a young boy with tuberculosis who developed DRESS syndrome after exposure to isoniazid. A 9-year-old boy, diagnosed clinically as pulmonary tuberculosis, presented with fever, fast breathing, maculopapular rash, and one episode of gross hematuria. He had been on 4-drug ATD therapy (isoniazid, rifampicin, ethambutol, and pyrazinamide) for the past 4 weeks. In view of multiorgan involvement and absence of a microbiological diagnosis of tuberculosis, vasculitis was considered and he was treated with steroids. As the child recovered, both corticosteroids and ATD therapy were stopped. At 6 months of follow-up, he was presented with pneumonia. Microbiological diagnosis of tuberculosis was made and 4-drug ATD therapy was reinitiated. After 15 days, he again developed a high-grade fever and rash. On evaluation, isoniazid-induced DRESS syndrome was diagnosed. Subsequently, he received a modified regimen of ethambutol, pyrazinamide, levofloxacin, and linezolid. DRESS syndrome did not recur on these ATDs and the child became asymptomatic. Linezolid was stopped after 3 months of therapy and ethambutol, pyrazinamide, and levofloxacin are being continued. Currently, he has completed 15 months of modified ATD therapy. As a high index of suspicion is required for early diagnosis and management that are crucial to reducing morbidity and mortality, DRESS syndrome should be among the differentials in children with unexplained febrile illnesses. Wolters Kluwer - Medknow 2022-06 2022-06-30 /pmc/articles/PMC9480812/ /pubmed/36119243 http://dx.doi.org/10.4103/jfmpc.jfmpc_1031_21 Text en Copyright: © 2022 Journal of Family Medicine and Primary Care https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Case Report
Patra, Pratap K.
Banday, Aaqib Z.
Jindal, Ankur K.
Bhattarai, Dharmagat
Patra, Nilamani
Saikia, Uma N.
Gupta, Anju
Suri, Deepti
DRESS syndrome due to first-line antitubercular therapy – A diagnostic imbroglio!
title DRESS syndrome due to first-line antitubercular therapy – A diagnostic imbroglio!
title_full DRESS syndrome due to first-line antitubercular therapy – A diagnostic imbroglio!
title_fullStr DRESS syndrome due to first-line antitubercular therapy – A diagnostic imbroglio!
title_full_unstemmed DRESS syndrome due to first-line antitubercular therapy – A diagnostic imbroglio!
title_short DRESS syndrome due to first-line antitubercular therapy – A diagnostic imbroglio!
title_sort dress syndrome due to first-line antitubercular therapy – a diagnostic imbroglio!
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9480812/
https://www.ncbi.nlm.nih.gov/pubmed/36119243
http://dx.doi.org/10.4103/jfmpc.jfmpc_1031_21
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