Patch-testing for the management of hypersensitivity reactions to second-line anti-tuberculosis drugs: a case report

BMC Research Notes

Petros Isaakidis¹  Peter Saranchuk³  Asha Pherwani²  Aristomo Andries¹  Samsuddin Khan¹ 

[1] Médecins Sans Frontières, Chandni Bungalow, Union Park, Off Carter Road, Khar (W), Mumbai 400 052, India;Allergy Immunology Department, P.D. Hinduja Hospital Research Center, Mumbai, India;Southern Africa Medical Unit (SAMU), Médecins Sans Frontières, Cape Town, South Africa

关键词: Skin patch test;    Drug allergy;    Co-infection;    Drug-resistant TB;    HIV;   

Others  :  1130426
DOI  :  10.1186/1756-0500-7-537

 received in 2014-04-13, accepted in 2014-08-11,  发布年份 2014

【 摘 要 】

Background

The second-line anti-tuberculosis drugs used in the treatment of multidrug-resistant tuberculosis often cause adverse events, especially in patients co-infected with the human immunodeficiency virus. Severe hypersensitivity reactions due to these drugs are rare and there is little published experience to guide their management.

Case presentation

A 17-year old Indian female multidrug-resistant tuberculosis patient co-infected with human immunodeficiency virus developed a hypersensitivity reaction after starting second-line anti-tuberculosis treatment in Mumbai, India. The patient was being treated with kanamycin, moxifloxacin, para-aminosalicylic acid, cycloserine, clofazimine, and amoxicillin-clavulanic acid. Twenty-four hours later, the patient developed generalized urticaria, morbilliform rash and fever. All drugs were suspended and the patient was hospitalised for acute management. Skin patch-testing was used to identify drugs that potentially caused the hypersensitivity reaction; results showed a strong reaction to clofazimine, moderate reaction to kanamycin and mild reaction to cycloserine. An interim second-line anti-tuberculosis regimen was prescribed; cycloserine and kanamycin were then re-challenged one-by-one using incremental dosing, an approach that allowed clinicians to re-introduce these drugs promptly and safely. The patient is currently doing well.

Conclusions

This is the first case-report of a multidrug-resistant tuberculosis patient co-infected with the human immunodeficiency virus with hypersensitivity reaction to multiple second-line anti-tuberculosis drugs. Skin patch-testing and controlled re-challenge can be a useful management strategy in such patients. There is an urgent need for second-line anti-tuberculosis regimens that are more effective, safe and better tolerated.

【 授权许可】

   
2014 Khan et al.; licensee BioMed Central Ltd.

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