与一线抗结核药物(ATD)相关的DRESS是具有挑战性的诊断。通过4种伴随给药的药物的长期联合治疗,识别罪魁祸首药物仍然很困难,可能会使患者遭受治疗中断并影响其预后。一位42岁的女性,用异烟肼治疗,利福平,吡嗪酰胺和乙胺丁醇治疗多灶性结核病,开发,40天后,热疗,面部水肿,颈部淋巴结肿大和全身性暴斑。生物检测结果显示嗜酸性粒细胞增多,非典型淋巴细胞,和肝损伤。DRESS被怀疑,ATD被撤回。由于4个ATD的补丁测试显示阴性结果,我们决定重新引入吡嗪酰胺,乙胺丁醇和利福平分开,间隔3天。吡嗪酰胺和利福平均耐受。然而,服用乙胺丁醇后,她出现了发烧和全身皮疹,没有生物学异常.由于乙胺丁醇被声称是罪魁祸首,添加了异烟肼,10个小时后,病人出现发热,面部水肿,全身性皮疹,嗜酸性粒细胞增多和肝损伤。这种临床和生物学模式在2周后解决。该报告表明异烟肼诱导的DRESS后对乙胺丁醇的超敏反应复发。
DRESS related to first-line antituberculosis drugs (ATD) is a challenging diagnosis. With a long-lasting combined treatment of 4-concomitantly administrated drugs, identification of the culprit drug remains difficult and may expose patients to treatment interruption and affect their outcome. A 42-year-old female, treated with isoniazid, rifampicin, pyrazinamide and ethambutol for multifocal tuberculosis, developed, 40 days later, hyperthermia, facial edema, cervical lymphadenopathy and generalized exanthema. Biological test results revealed eosinophilia, atypical lymphocytes, and liver injury. DRESS was suspected, and ATD were withdrawn. As patch tests for the 4 ATD showed negative results, we decided to reintroduce pyrazinamide, ethambutol and rifampicin separately with a 3-day interval. Pyrazinamide and rifampicin were tolerated. However, after receiving ethambutol, she developed fever and generalized rash, with no biological abnormalities. Since ethambutol was claimed to be the culprit drug, isoniazid was added, and 10 hours later, the patient developed fever, facial edema, generalized rash, eosinophilia and liver injury. This clinical and biological pattern resolved 2 weeks later. This report suggests a hypersensitivity relapse to ethambutol after isoniazid-induced DRESS.