Sharma Reena K, Verma Ghanshyam K, Tegta Gita Ram, Sood Samriti, Rattan Renu, Gupta Mudita
Department of Dermatology, Venereology and Leprosy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
Indian Dermatol Online J. 2020 Mar 9;11(2):177-181. doi: 10.4103/idoj.IDOJ_133_19. eCollection 2020 Mar-Apr.
Tuberculosis (TB) is a major global health problem and leading cause of death. Anti-tubercular therapy (ATT) can lead to various adverse effects including cutaneous reactions. Re-challenge remains the only option to restart the safe therapy with limited number of most efficient primary ATT drugs.
To study the demographic profile, identify the spectrum of cutaneous eruptions, offending drug and the reinstitution of safe ATT.
This was a retrospective study with inclusion of the indoor patients with cutaneous adverse drug reaction secondary to ATT. Hospital records were analyzed regarding demographic characteristics, type of TB, ATT regimen, pattern of drug rash, offending drugs, laboratory parameters, and reinstitution of ATT after re-challenge.
All the cases (40 patients) were reported in adults with male to female ratio of 1:1.2 and mean age of 50 years. Pulmonary TB was the most common type of TB observed in 24 (60%) patients followed by extra-pulmonary in 16 (40%) patients. Maculopapular rash was the most common (42.5%) type of cutaneous eruptions and ethambutol, the most common (45%) offending drug followed by other first line anti-tubercular drugs. Ten (25%) patients developed multiple drug hypersensitivity on re-challenging. Multiple drug hypersensitivity was seen in 10 (25%) patients.
Drug reaction to ATT is like a double-edged sword as stopping ATT and starting treatment of reaction with systemic steroids can further aggravate the condition with increased risk of disseminated and multidrug resistant tuberculosis. Re-challenge with ATT not only find out the culprit drug but also helps to restart a safer alternate ATT regimen.
Small sample size, lack of proper hospital records due to which some patients were missed and the fact that re-challenge was not performred in mild lichenoid type rash.
结核病是一个重大的全球健康问题，也是主要的死亡原因。抗结核治疗（ATT）可导致包括皮肤反应在内的各种不良反应。再次激发试验仍然是使用数量有限的最有效的一线抗结核药物重新开始安全治疗的唯一选择。
研究人口统计学特征，确定皮肤疹的范围、致病药物以及重新开始安全抗结核治疗的情况。
这是一项回顾性研究，纳入了因抗结核治疗继发皮肤药物不良反应的住院患者。分析医院记录中的人口统计学特征、结核病类型、抗结核治疗方案、药疹类型、致病药物、实验室参数以及再次激发试验后重新开始抗结核治疗的情况。
所有病例（40例患者）均为成年人，男女比例为1:1.2，平均年龄50岁。肺结核是最常见的结核病类型，24例（60%）患者出现，其次是肺外结核，16例（40%）患者出现。斑丘疹是最常见的（42.5%）皮肤疹类型，乙胺丁醇是最常见的（45%）致病药物，其次是其他一线抗结核药物。10例（25%）患者在再次激发试验时出现多种药物超敏反应。10例（25%）患者出现多种药物超敏反应。
抗结核治疗的药物反应就像一把双刃剑，因为停止抗结核治疗并开始用全身性类固醇治疗反应可能会进一步加重病情，增加播散性和耐多药结核病的风险。对抗结核治疗进行再次激发试验不仅可以找出致病药物，还有助于重新开始更安全的替代抗结核治疗方案。
样本量小，由于缺乏适当的医院记录，一些患者被遗漏，并且轻度苔藓样皮疹未进行再次激发试验。
