Permatasari Aghnia, Soegiarto Gatot
Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic, Surabaya, Indonesia.
Ann Med Surg (Lond). 2022 Aug 27;81:104512. doi: 10.1016/j.amsu.2022.104512. eCollection 2022 Sep.
Anti-tuberculosis drugs (ATD) induced DRESS syndrome is rarely reported, and its diagnosis and management are very challenging.
A 33-year-old woman presented with fever, maculopapular rashes, hypereosinophilia, and hepatic involvement, which occurred 4 weeks after a fixed-dose combination of first-line ATD containing rifampicin, isoniazid, pyrazinamide, and ethambutol. The patient's condition improved after the withdrawal of the drugs and administration of systemic steroids. Furthermore, active pulmonary tuberculosis was treated with second-line ATD containing streptomycin, levofloxacin, and ethambutol with no adverse reaction.
Early identification of the causal drug for ATD-induced DRESS syndrome is essential, and it helps to facilitate the treatment process. In some cases, the change from first-line ATD to second-line in pulmonary tuberculosis patients with the syndrome can be considered after recovery with strict follow-up. Furthermore, the administration of systemic corticosteroids for tuberculosis treatment is still debatable, but it had positive effects in this study.
Early recognition and withdrawal of all suspected drugs are crucial in managing DRESS because the delayed diagnosis can be life-threatening. The administration of systemic steroids is effective against DRESS in pulmonary tuberculosis infection.
抗结核药物（ATD）诱发的药物超敏反应伴嗜酸性粒细胞增多和系统症状（DRESS）综合征鲜有报道，其诊断和管理极具挑战性。
一名33岁女性出现发热、斑丘疹、嗜酸性粒细胞增多和肝脏受累，这些症状在服用含利福平、异烟肼、吡嗪酰胺和乙胺丁醇的一线固定剂量复方抗结核药物4周后出现。停药并给予全身用类固醇后，患者病情好转。此外，活动性肺结核采用含链霉素、左氧氟沙星和乙胺丁醇的二线抗结核药物治疗，未出现不良反应。
早期识别ATD诱发DRESS综合征的致病药物至关重要，有助于推动治疗进程。在某些情况下，患有该综合征的肺结核患者康复后，可考虑在严格随访的情况下从一线抗结核药物转换为二线药物。此外，全身用皮质类固醇用于结核病治疗仍存在争议，但在本研究中显示出积极效果。
早期识别并停用所有可疑药物对管理DRESS至关重要，因为延迟诊断可能危及生命。全身用类固醇对肺结核感染中的DRESS有效。
