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Journal Article > Case Report/Series

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

Andries A, Pherwani A, Saranchuk P, Isaakidis P
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Abstract
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.
Countries
India
Subject Area
antibiotic resistancetuberculosisantimicrobial resistanceHIV/AIDS
DOI
10.1186/1756-0500-7-537
Published Date
15-Aug-2014
PubMed ID
25128289
Languages
English
Journal
BMC Research Notes
Volume / Issue / Pages
Volume 7, Issue 1, Pages 537
Issue Date
01-Jan-2014
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