CASE REPORT ON DRESS SYNDROME INDUCED BY ANTITUBERCULOSIS DRUGS

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe adverse drug reaction characterized by an extensive skin rash in association with visceral organ involvement, lymphadenopathy, eosinophilia, and atypical lymphocytosis. We report a rare case of DRESS Syndrome secondary to anti tubercular treatment (ATT). A 53 year old male with pulmonary tuberculosis (TB) presented with fever, facial puffiness, bilateral pedal edema, itchy exfoliative rashes over face, thorax, abdomen, and extremities for 15 days after about 4 months of starting FDC of ATT. On examination there was hypotension (BP-80/60 mm Hg) and bilateral diffuse symmetrical exfoliative dermatitis over face, chest, abdomen, all 4 extremities sparing flexor aspect of thighs and legs. Investigations revealed eosinophilia, leucocytosis (predominantly lymphocytosis), raised alkaline phosphatase and acute kidney injury. FDC was withheld, skin biopsy was performed and the patient was managed as DRESS syndrome fulfilling diagnostic criteria with oral steroids (prednisolone 1mg/kg/day) and other supportive medications. The patient improved gradually with improvement in most of the symptoms and progressive return of laboratory parameters towards normal level. Individuals diagnosed with pulmonary TB who are undergoing treatment with FDC of ATT have a heightened susceptibility to DRESS. The timely identification and cessation of the offending agent can effectively mitigate mortality.