PDF(Pubmed)
Abstract：
UNASSIGNED: Tuberculosis (TB) is the second leading cause of death due to an infectious disease worldwide (World Health Organization, 2022 [1]). The first line treatment of TB involves the concurrent use of four drugs: rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE). Given the rising threat of multidrug resistant TB, it is crucial to understand how TB can be treated when first line treatment is not an option.
UNASSIGNED: We report a rare case of multi-drug hypersensitivity to RIPE therapy in an immunocompetent patient with an unusual presentation of CNS tuberculoma. The patient presented to an outside hospital four months prior with weakness, numbness, imbalance, and speech difficulties. A CT of the head revealed a mass in the left parietal lobe that demonstrated chronic necrotizing granulomatous inflammation with positive cultures for M. tuberculosis. The patient was started on a regimen of rifampin 600 mg daily, isoniazid 300 mg daily, pyrazinamide 2000 mg daily, ethambutol 1200 mg daily, and pyridoxine 50 mg daily. However, the patient developed drug hypersensitivity reactions to both rifampin and ethambutol with subsequent failed desensitization to rifabutin. She was ultimately discharged from the hospital on a regimen of isoniazid, pyridoxine, pyrazinamide, and moxifloxacin with plans for outpatient follow-up.
UNASSIGNED: This case highlights a rare clinical presentation of multiple drug hypersensitivity in the setting of a CNS tuberculoma and the importance of identifying the offending agents early in the course of treatment and adjusting the drug regimen accordingly. Desensitization should be attempted, but if ineffective, then alternative drug regimens should be formulated on a case-by-case basis.
UNASSIGNED: We report a rare case of multi-drug hypersensitivity to RIPE therapy in an immunocompetent patient with an unusual presentation of CNS tuberculoma. The patient presented to an outside hospital four months prior with weakness, numbness, imbalance, and speech difficulties. A CT of the head revealed a mass in the left parietal lobe that demonstrated chronic necrotizing granulomatous inflammation with positive cultures for M. tuberculosis. The patient was started on a regimen of rifampin 600 mg daily, isoniazid 300 mg daily, pyrazinamide 2000 mg daily, ethambutol 1200 mg daily, and pyridoxine 50 mg daily. However, the patient developed drug hypersensitivity reactions to both rifampin and ethambutol with subsequent failed desensitization to rifabutin. She was ultimately discharged from the hospital on a regimen of isoniazid, pyridoxine, pyrazinamide, and moxifloxacin with plans for outpatient follow-up.
UNASSIGNED: This case highlights a rare clinical presentation of multiple drug hypersensitivity in the setting of a CNS tuberculoma and the importance of identifying the offending agents early in the course of treatment and adjusting the drug regimen accordingly. Desensitization should be attempted, but if ineffective, then alternative drug regimens should be formulated on a case-by-case basis.
摘要：
■结核病（TB）是世界范围内由传染病引起的第二大死亡原因（世界卫生组织，2022年[1]）。结核病的一线治疗包括同时使用四种药物：利福平，异烟肼,吡嗪酰胺,和乙胺丁醇（RIPE）。鉴于耐多药结核病的威胁不断上升，当一线治疗不是一种选择时,了解如何治疗结核病至关重要.
■我们报告了一例罕见的对RIPE治疗的多药超敏反应的病例，患者有异常的中枢神经系统结核瘤表现。患者在四个月前因虚弱而被送往外部医院，麻木,不平衡,和言语困难。头部CT显示左顶叶有肿块，显示慢性坏死性肉芽肿性炎症，结核分枝杆菌培养阳性。患者开始每天服用利福平600毫克，异烟肼每天300毫克，吡嗪酰胺每天2000毫克，乙胺丁醇每天1200毫克，和吡哆醇50毫克每日。然而,患者出现了对利福平和乙胺丁醇的药物超敏反应,随后对利福布汀脱敏失败.她最终通过异烟肼方案出院，吡哆醇,吡嗪酰胺,莫西沙星和门诊随访计划。
■该病例突出了在中枢神经系统结核瘤的背景下，多药超敏反应的罕见临床表现，以及在治疗过程中早期确定不良药物并相应调整药物方案的重要性。应该尝试脱敏，但如果无效,则应根据具体情况制定替代药物方案。
■我们报告了一例罕见的对RIPE治疗的多药超敏反应的病例，患者有异常的中枢神经系统结核瘤表现。患者在四个月前因虚弱而被送往外部医院，麻木,不平衡,和言语困难。头部CT显示左顶叶有肿块，显示慢性坏死性肉芽肿性炎症，结核分枝杆菌培养阳性。患者开始每天服用利福平600毫克，异烟肼每天300毫克，吡嗪酰胺每天2000毫克，乙胺丁醇每天1200毫克，和吡哆醇50毫克每日。然而,患者出现了对利福平和乙胺丁醇的药物超敏反应,随后对利福布汀脱敏失败.她最终通过异烟肼方案出院，吡哆醇,吡嗪酰胺,莫西沙星和门诊随访计划。
■该病例突出了在中枢神经系统结核瘤的背景下，多药超敏反应的罕见临床表现，以及在治疗过程中早期确定不良药物并相应调整药物方案的重要性。应该尝试脱敏，但如果无效,则应根据具体情况制定替代药物方案。
