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Antituberculosis Drug-Induced Fixed Drug Eruption: A Case Report.

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Fixed-dose combination (FDC) antituberculosis drugs caused a fixed drug eruption (FDE) in a patient with a history of drug allergy. FDCs should be avoided in such patients to prevent complex adverse drug reactions.

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Area of Science:

  • Pharmacology
  • Dermatology
  • Infectious Diseases

Background:

  • Fixed drug eruption (FDE) is a type of adverse drug reaction characterized by recurrent skin lesions at the same site upon re-exposure to a causative agent.
  • Antituberculosis therapy often involves fixed-dose combinations (FDCs) for patient convenience and adherence.
  • Patients with a history of drug allergies may be at increased risk for adverse drug reactions.

Purpose of the Study:

  • To report a case of fixed drug eruption caused by a fixed-dose combination of antituberculosis drugs.
  • To highlight the potential risks associated with using FDCs in patients with a history of drug allergies.
  • To emphasize the importance of identifying individual drug components in FDCs for accurate diagnosis and management of adverse reactions.

Main Methods:

  • A case study of a 40-year-old male patient diagnosed with pulmonary tuberculosis.
  • The patient developed a fixed drug eruption after initiating treatment with tablet Forecox®, an FDC containing rifampicin, isoniazid, pyrazinamide, and ethambutol.
  • Causality assessment was performed using the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) criteria and the Naranjo scale. Severity was assessed using the Modified Hartwig and Siegel scale.

Main Results:

  • The patient developed FDE after the third dose of the FDC antituberculosis medication.
  • The reaction resolved within 15 days after discontinuation of the FDC and appropriate treatment for FDE.
  • Causality assessment indicated a possible and probable association between the FDC and the FDE, respectively. The reaction was classified as moderately severe.

Conclusions:

  • Fixed-dose combinations of antituberculosis drugs can cause fixed drug eruptions, particularly in patients with a history of drug allergies.
  • The use of FDCs complicates the identification of the specific culprit drug in cases of adverse drug reactions.
  • It is recommended to avoid FDCs in patients with a history of drug allergies to prevent complex allergic reactions and facilitate accurate diagnosis.