Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome induced by first-line antitubercular medication: A case series

• Published in: Revue française d'allergologie (2009) 2024-04, Vol.64, p.103941, Article 103941
• Main Authors: Ben Belgacem, M., Zgolli, F., Charfi, O., Aouinti, I., Lakhoua, G., Daghfous, R., El Aidli, S.
• Format: Article
• Language: fre
• ISSN: 1877-0320; 1877-0320
• DOI: 10.1016/j.reval.2024.103941

(contexte de la recherche) Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a severe and potentially life-threatening hypersensitivity reaction, Anti-tuberculosis drug (ATD)-induced DRESS syndrome is uncommon. To characterize the clinical presentation, management, and outcomes of DRESS syndrome induced by first-line ATD. A descriptive retrospective study over a period of 6 years between 2017 and 2023 about cases of DRESS syndrome induced by first-line ATD (rifampicin(RIF), isoniazid(INH), pyrazinamide(PYZ) and ethambutol(ETB)) notified to The Tunisian National Center of Pharmacovigilance.These cases were assessed according to the RegiSCAR criteria and we retained only cases with a score >2 (possible, probable or definite case)[1].The drug imputability was evaluated according to the updated French method of imputability[2]. We have collected 15 cases. Clinical presentation was variable, with an average onset time of 28 days(10 to 49 days), with cutaneous involvement in all cases, systemic involvement in 14 cases, and hypereosinophilia in10 cases. Biopsy confirmed the diagnosis in 2 cases.The RegiSCAR score was possible in10 patients and probable in 5 others. Symptoms progressively resolved after two weeks(15 to 30 days) of drug withdrawal and using corticosteroids. In view of the therapeutic need, and the absence of other therapeutic alternatives in certain situations, sequential reintroduction of ATD, under medical supervision, was proposed in 4 cases, with negative reintroduction of INH(3), RIF(3) and PYZ(1), and positive reintroduction of INH in 1 case and ETB in another case. Finally, a successful desensitization protocol was considered in two patients. DRESS syndrome induced by ATD is a rare but potentially severe. Early recognition, withdrawal of the offending drugs, and appropriate management are crucial.