Abstract |
We present the case of a drug reaction with eosinophilia and systemic symptoms (DRESS) manifesting multi-organ dysfunction syndrome ( MODS) that led to death in an elderly patient during the intensive phase of antitubercular therapy (ATT). A 74-year-old male developed skin rash (morbilliform), patchy erythematous macules, pustular-purpuric nonblanching spots, fever, lymphadenopathy, liver dysfunction, leukocytosis, and eosinophilia during intensive phase of ATT (ATT: day 45). Laboratory tests revealed hypereosinophilia (eosinophils; 10500/μL), hyperacute fulminant hepatic failure ( aspartate transaminase/ alanine transaminase; 1444/1375 IU/L, total bilirubin; 11.3 mg/dL), hepatic encephalopathy (Child-Pugh score: 15), coagulopathy (international normalized ratio; 3.0 and activated partial thromboplastin time; 52 s), and acute renal failure (serum creatinine; 2.6 mg/dL). The patient was diagnosed with DRESS with a RegiSCAR score of 7 (definite). ATT was discontinued. Despite immediate treatment with pulse methylprednisolone, N-acetylcysteine and sustained low-efficiency dialysis, the patient's clinical condition evolved to shock due to MODS (sequential organ failure Assessment: 15 points), and on day 51, he succumbed. Concluding, an elderly patient with high-dose antitubercular drugs needs a clinical management review. Clinical symptoms pertaining to DRESS may paradoxically worsen after 3-4 days of discontinuation of the offending drug.
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Authors | Bijoy Kumar Panda, Vaibhav Rajendra Suryawanshi, Asawari Raut, Samrudhi Joshi, Bharat Purandare |
Journal | International journal of mycobacteriology
(Int J Mycobacteriol)
2023 Jul-Sep
Vol. 12
Issue 3
Pg. 360-363
ISSN: 2212-554X [Electronic] India |
PMID | 37721245
(Publication Type: Review, Case Reports)
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Chemical References |
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Topics |
- Male
- Humans
- Aged
- Drug Hypersensitivity Syndrome
(diagnosis, etiology, therapy)
- Antitubercular Agents
(adverse effects)
- Multiple Organ Failure
(complications)
- Eosinophilia
(complications)
- Fever
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