Shrestha Ramesh, Jha Shivendra K, Bartaula Jasmine
Infectious Disease, Sukraraj Tropical and Infectious Disease Hospital, Kathmandu, NPL.
Dermatology, Venerology and Leprology, Sukraraj Tropical and Infectious Disease Hospital, Kathmandu, NPL.
Cureus. 2021 Nov 3;13(11):e19223. doi: 10.7759/cureus.19223. eCollection 2021 Nov.
Drug reaction with eosinophilia and systemic symptoms (DRESS) is an idiosyncratic severe cutaneous adverse reaction (SCAR) characterized by a skin rash with systemic involvement (e.g., hematological, solid organ abnormalities). Various medications, most commonly anticonvulsants (carbamazepine, phenytoin), antibiotics (vancomycin, amoxicillin), and sulfa drugs (dapsone, sulfasalazine), have been implicated. We report a case of a 75-year-old man with pulmonary tuberculosis under anti-tubercular treatment (ATT Category 1 as per the national guidelines of Nepal) presenting with rash, fever, liver dysfunction, and eosinophilia, a combination of features suggestive of DRESS. According to the national tuberculosis (TB) survey of 2018-2019, over 117,000 people in Nepal were living with TB, including 69,000 newly diagnosed people. In third-world countries, such as Nepal, with a high TB prevalence, and the Southeast Asian region (with a huge percentage of the global burden of TB incidence), the risk of life-threatening adverse drug reactions during ATT is high. However, a good response is seen if it is recognized early and on stopping ATT and receiving a course of steroids and emollients.
药物超敏反应伴嗜酸性粒细胞增多和全身症状（DRESS）是一种特异质性严重皮肤不良反应（SCAR），其特征为伴有全身受累（如血液学、实体器官异常）的皮疹。多种药物，最常见的是抗惊厥药（卡马西平、苯妥英）、抗生素（万古霉素、阿莫西林）和磺胺类药物（氨苯砜、柳氮磺胺吡啶），都与之有关。我们报告一例75岁男性，正在接受抗结核治疗（按照尼泊尔国家指南属于1类抗结核治疗），患有肺结核，出现皮疹、发热、肝功能障碍和嗜酸性粒细胞增多，这些特征组合提示为DRESS。根据2018 - 2019年全国结核病调查，尼泊尔有超过11.7万人患有结核病，其中包括6.9万新诊断患者。在尼泊尔这样结核病患病率高的第三世界国家以及东南亚地区（全球结核病发病率负担占很大比例），抗结核治疗期间发生危及生命的药物不良反应的风险很高。然而，如果早期识别并停用抗结核治疗，给予一个疗程的类固醇和润肤剂，会有良好的反应。
