Two cases of multiple drug allergy syndrome in patients treated with combination regimen of antituberculosis medication

Abstract

Background Patients with multiple drug allergy syndrome (MDAS) have a predilection to more than one non-cross-reacting medication. Although adverse reactions to antituberculosis medication are relatively common, there have been few reports of MDAS to antituberculosis drugs. Here we report two cases of MDAS in young women treated with first line antituberculosis drugs, including isoniazid (INH), rifampin (RFP), ethambutol (EMB), and pyrazinamide (PZA). Case1 A 20-year-old woman with systemic lupus erythematosis was diagnosed as intestinal tuberculosis based on colonoscopic biopsy and started to take INH only. She developed nausea, vomiting, diarrhea, and chest tightness four days after medication and high fever and elevation of liver transaminase levels were detected 11 days later. Fever disappeared after discontinuation of INH and administration of system steroid. RFP, EMB, PZA, levofloxacin was prescribed for treatment of intestinal tuberculosis and fever developed again 10 days later. All anti-tuberculosis medication was stopped and readministration of INH caused fever, chest discomfort, and headache again. RFP induced fever, severe angioedema and anaphylactic shock within one hour of RFP intake. Intradermal skin test showed positive reaction to RFP, not to INH. Case 2 A 20-year-old woman developed neutropenia after antituberculosis medication. She was diagnosed to have tuberculous lymphadenitis around neck during subtotal thyroidectomy for treatment of thyroid cancer. All medications were withdrawn except thyroid hormone and neuropenia recovered. While restart of INH was tolerated, EMB induced fever and headache. Administration of RFP caused acute urticaria accompanied by fever and headache.