이차 항결핵제에 약물과민반응증후군을 보인 다제내성 결핵 환자에서 급속 탈감작요법에 준한 항결핵제 재투여 1예
Successful readministration of second-line antituberculous agents in a patient with near-fatal drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome
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For the treatment of multidrug-resistant (MDR) tuberculosis, maintenance of appropriate antituberculous agents is essential because of its low cure rate and high dropout rate. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe drug-induced systemic hypersensitivity response resulting in cessation of causative agents. In cases of second-line antituberculous agent-induced DRESS, it is extremely difficult to find other replacement medications to cure MDR tuberculosis. A 53-year-old male who had taken the second-line antituberculous agents (cycloserine, streptomycin, p-aminosalicylic acid, and prothionamide) as well as pyrazinamide for 5 weeks experienced DRESS syndrome accompanying hepatic coma. His symptoms improved with discontinuation of antituberculous agents and administration of high-dose methylprednisolone for 1 month. To resume the antituberculous medication, second-line antituberculous agents were administered one by one using a rapid desensitization protocol. While kanamycin, levofloxacin, and cycloserine were successfully readministered, p-aminosalicylic acid- and prothionamide-induced cutaneous hypersensitivity symptoms were relatively mild compared to previous reactions. Herein, we report a case of successfully treated MDR tuberculosis having a history of fatal DRESS syndrome to antituberculous agents using the rapid desensitization protocol.
Abstract
For the treatment of multidrug-resistant (MDR) tuberculosis, maintenance of appropriate antituberculous agents is essential because of its low cure rate and high dropout rate. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe drug-induced systemic hypersensitivity response resulting in cessation of causative agents. In cases of second-line antituberculous agent-induced DRESS, it is extremely difficult to find other replacement medications to cure MDR tuberculosis. A 53-year-old male who had taken the second-line antituberculous agents (cycloserine, streptomycin, p-aminosalicylic acid, and prothionamide) as well as pyrazinamide for 5 weeks experienced DRESS syndrome accompanying hepatic coma. His symptoms improved with discontinuation of antituberculous agents and administration of high-dose methylprednisolone for 1 month. To resume the antituberculous medication, second-line antituberculous agents were administered one by one using a rapid desensitization protocol. While kanamycin, levofloxacin, and cycloserine were successfully readministered, p-aminosalicylic acid- and prothionamide-induced cutaneous hypersensitivity symptoms were relatively mild compared to previous reactions. Herein, we report a case of successfully treated MDR tuberculosis having a history of fatal DRESS syndrome to antituberculous agents using the rapid desensitization protocol.
참고문헌 (12)
- 김희진, "한국에서의 결핵현황", 대한내과학회지, 82(3), pp.257~262 (2012), 대한내과학회
- Kim DH, "Treatment outcomes and long-term survival in patients with extensively drug-resistant tuberculosis", Am J Respir Crit Care Med, 178, pp.1075~1082 (2008)
- Walsh SA, "Drug reaction with eosinophilia and systemic symptoms(DRESS) : a clinical update and review of current thinking", Clin Exp Dermatol, 36, pp.6~11 (2011)
- Cacoub P, "The DRESS syndrome : a literature review", Am J Med, 124, pp.588~597 (2011)
- Galvao VR, "Clinical and laboratory improvement after intravenous immunoglobulin in drug reaction with eosinophilia and systemic symptoms", J Allergy Clin Immunol Pract, 2, pp.107~110 (2014)
- Joly P, "Poor benefit", risk balance of intravenous immunoglobulins in DRESS, 2012, pp.148, 543~544
- Santhamoorthy P, "Intravenous immunoglobulin in the treatment of drug rash eosinophilia and systemic symptoms caused by phenytoin", Ann Indian Acad Neurol, 15, pp.320~322 (2012)
- Chiriac AM, "Multiple drug hypersensitivity syndrome", Curr Opin Allergy Clin Immunol, 13, pp.323~329 (2013)
- Scherer K, "Desensitization in delayed drug hypersensitivity reactions : an EAACI position paper of the Drug Allergy Interest Group", Allergy, 68, pp.844~852 (2013)
- Holland CL, "Rapid oral desensitization to isoniazid and rifampin", Chest, 98, pp.1518~1519 (1990)
- Matz J, "Oral desensitization to rifampin and ethambutol in mycobacterial disease", Am J Respir Crit Care Med, 149(3 Pt 1), pp.815~817 (1994)