JM case report session

Background: Tuberculosis is still an important public health problem in our country.Although first-line antituberculosis drugs are considered effective and safe, serious side effects can also occur.One of these side effect is drug-related Type 1 hypersensitivity reactions.Case: A 16-year-old male patient, who had no previous history of drug allergy, was diagnosed with pulmonary tuberculosis and was receiving INH 300 mg, Rifampicin 600 mg, pyrazinamide 1500 mg, Ethambutol 1000 mg treatments for 15 days, but his treatment was interrupted for two weeks due to elevated liver function tests and an increase in acute phase reactants, and then the treatment was started again.After one hour, the symptoms were assessed as anaphylactic shock, characterized by chills, weakness, headache, redness of the eyes, vomiting, low blood pressure, rapid heart rate, mucocutaneous symptoms, and gastrointestinal complaints.Intramuscular adrenaline was administered twice due to unresponsiveness.IV fluid therapy was administered twice as a result of persistent low blood pressure.He was followed up in the pediatric intensive care unit with adrenaline infusion.The patient was admitted to our center due to cavitary tuberculosis and the need for anti-TBC treatment.Skin prick tests performed with anti-TBC drugs were negative.The patient was first desensitized with rifampicin in 2 days and with isoniazid in 3 days.Pyrazinamide desensitization was initiated as the third drug. 1 hour and 10 minutes after desensitization was completed, he had vomiting, fever and headache.Septic screenings were found to be negative.IV clindamycin and vancomycin were started.Cranial imaging was found to be normal.During the follow-up, ST elevation (1 mm) was observed on the ECG, and follow-up by pediatric cardiology was recommended.The desensitization protocol with pyrazinamide was discontinued.Desensitization to ethambutol was performed without any problems in 2 days.Treatment with moxifloxacin was started instead of pyrazinamide.The patient is currently continuing his quadruple TBC treatment without any problems.