Kato Yukihiko, Sato Yu, Nakasu Miho, Tsuboi Ryoji
1Department of Dermatology, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-8524 Japan.
3Department of Dermatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjukuku, Tokyo, 160-0023 Japan.
Allergy Asthma Clin Immunol. 2018 Apr 3;14:13. doi: 10.1186/s13223-018-0237-x. eCollection 2018.
We experienced a rare case of immediate type hypersensitivity and late phase reaction to anti-tubercular therapy consisting of ethambutol and levofloxacin, which occurred in close succession, giving the appearance of a single, continuous reaction to one drug.
The patient was a man in his 70's who began therapy consisting of isoniazide, rifampicin, and ethambutol for pulmonary tuberculosis. Since the patient had a drug eruption within several hours after the start of his treatment, his reaction to ethambutol was assessed first among the three suspected drugs using an oral challenge test. Levofloxacin, which was not among the suspected drugs, was administered with ethambutol in order to avoid drug resistance resulting from the administration of a single drug. The patient experienced pruritus within 1 h. We observed a well-defined, edematous erythema with induration, which persisted for several days after the patient received the two drugs. Next, skin tests were performed with ethambutol and levofloxacin. The skin reaction to ethambutol and levofloxacin consisted of two different types of allergic reaction, a immediate type reaction and phase reaction.
This is the first report of a late phase reaction and immediate type hypersensitivity occurring in quick succession in the same patient. Subsequent skin tests were able to prove the presence of these two different types of allergic reactions.
我们遇到了一例罕见的对抗结核治疗（由乙胺丁醇和左氧氟沙星组成）的速发型超敏反应和迟发相反应，这两种反应相继发生，给人一种对单一药物的单一、连续反应的表象。
患者为一名70多岁男性，开始接受异烟肼、利福平及乙胺丁醇治疗肺结核。由于患者在开始治疗后数小时内出现药物疹，因此首先使用口服激发试验在三种可疑药物中评估其对乙胺丁醇的反应。为避免单一用药产生耐药性，将未列入可疑药物的左氧氟沙星与乙胺丁醇联合使用。患者在1小时内出现瘙痒。在患者接受这两种药物治疗后，我们观察到边界清晰、伴有硬结的水肿性红斑，持续了数天。接下来，对乙胺丁醇和左氧氟沙星进行了皮肤试验。对乙胺丁醇和左氧氟沙星的皮肤反应由两种不同类型的过敏反应组成，即速发型反应和迟发相反应。
这是首例同一患者中速发型超敏反应和迟发相反应相继快速发生的报告。随后的皮肤试验能够证实这两种不同类型过敏反应的存在。
