Anti-Tuberculosis Treatment Induced DRESS Syndrome – A Case Report

Abstract

Introduction: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a medical condition that is a severe adverse drug event. Anti-tuberculosis medications may precipitate this condition. Study Design: Case presentation. Place and Duration of Study: Sample: Department of internal Medicine, and Department of Pathology, Krishna Institute of Medical Sciences (KIMS) Hospital, HYDERABAD, Methodology: A 73-year-old gentleman had complaints suggestive of left ankle arthritis of 8 months duration and was diagnosed with tuberculous osteomyelitis 6 weeks ago based on positive Gene-Expert® MTB/RIF(mycobacterium tuberculosis resistant rifampicin) and necrotizing granulomatous inflammation on histopathology. He was started on anti-tuberculosis treatment and presented 6 weeks later with high-grade fever, generalized rashes, and itching. Eosinophilia was noted in the complete hemogram and liver enzymes were elevated. Skin biopsy showed SJS (Stevens-Johnson syndrome). He was diagnosed as drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. It was most likely caused by Anti-Tuberculosis medications. His tuberculosis medications were modified and steroids were started after which his condition improved. Discussion: This case presentation depicts, most of the first-line anti-tuberculosis medications can cause DRESS Syndrome. Clinical suspicion and early diagnosis with appropriate tests help to treat this condition early without any significant morbidity and mortality. The causative drug should be withdrawn, Steroids, and Intravenous immunoglobulin-g can be used for the treatment depending on the severity.