Rifampicin-Associated Sweet Syndrome: An Uncommon Adverse Event of Anti-Tuberculosis Therapy

Area of Science:

• Dermatology
• Infectious Diseases
• Pharmacology

Background:

• Sweet syndrome (acute febrile neutrophilic dermatosis) is a rare inflammatory condition.
• It can be triggered by infections, malignancy, autoimmune diseases, or drugs.
• Association with tuberculosis is uncommon, and rifampicin-induced cases are infrequent.

Purpose of the Study:

• To report a case of Sweet syndrome secondary to rifampicin in a patient with disseminated tuberculosis.
• To emphasize the diagnostic challenge and management of drug-induced Sweet syndrome during tuberculosis treatment.

Main Methods:

• Case presentation of a 58-year-old male with disseminated tuberculosis.
• Clinical observation of skin eruption onset after starting antituberculous therapy (ATT).
• Assessment of eruption response to corticosteroids and recurrence upon rifampicin rechallenge.

Main Results:

• The patient developed painful erythematous plaques after initiating ATT.
• The eruption resolved with corticosteroids but recurred upon rifampicin rechallenge.
• Rifampicin was discontinued, and the patient successfully completed ATT with other first-line drugs.

Conclusions:

• Rifampicin-induced Sweet syndrome is a rare but crucial differential diagnosis in patients on ATT presenting with erythematous plaques.
• Accurate diagnosis enables continuation of essential tuberculosis treatment.
• Avoiding unnecessary discontinuation of other first-line ATT drugs is vital for treatment success.