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Colegio de Medicina Interna de México.

2021, Number 5

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Med Int Mex 2021; 37 (5)

Hypersensitivity reaction due to antitubercular agents in an HIV patient

Rangel-Rivera DA, Figueroa-Pineda CL, Coronado-Galán A, Peñaranda-Hernández PA, Ibáñez-Yemail NS

Language: Spanish
References: 28
Page: 861-866
PDF size: 231.73 Kb.


ABSTRACT

Background: The drug hypersensitivity reaction to first-line anti-tuberculosis drugs is uncommon in treated patients, with manifestations ranging from urticaria, pruritus or angioedema, to anaphylactic shock potentially deadly. It is caused by the stimulation of B lymphocytes which produces IgE antibodies, that unleashes the process of immune response against drugs or their metabolites. There is no clear description of hypersensitivity to anti-tuberculosis drugs, which represents barriers to clinical intervention, due to the few treatment options to fight this infectious agent and the lack of management guidelines for these cases.
Clinical case: A 31-year-old female patient with a history of HIV, in category I tetra-conjugate drug therapy against pulmonary tuberculosis. The patient presented a series of hypersensitivity reactions, from skin manifestations (pruritus and rash) to blood pressure compromise attributed to the pharmacological management that required treatment with vasopressors.
Conclusions: Although adherence to treatment avoids antimicrobial resistance cases, it can be influenced by various adverse effects, including hypersensitivity to the drug. For this reason, a complex medical approach is needed in such situations, including suspension of treatment, desensitization and gradual readministration of the medication.


REFERENCES

  1. Kumar V, Abbas AK, Aster JC. Robbins y Cotran - Patología estructural y funcional. 9ª ed. Barcelona: Elsevier 2015: 371-376.

  2. Pinilla RA, Murgueitio CR, Calderón VC, Mesa UA, Villalobos MW, Espinosa TF, Vega MT. Compendio de terapéutica, evidencia actual. 6ª ed. Bogotá: Celsus; 2017: 716-728.

  3. Ministerios de salud y protección social de la república de Colombia. Circular 007 de 2015.

  4. Guidelines for treatment of drug-susceptible tuberculosis and patient care, 2017 update. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.

  5. Nagarajan S, Whitaker P. Management of adverse reactions to first-line tuberculosis antibiotics. Curr Opin Allergy Clin Immunol 2018; 18: 333-341. doi: 10.1097/ ACI.0000000000000462.

  6. Arrossi S, Herrero MB, Greco A, Ramos S. Factores predictivos de la no adherencia al tratamiento de la tuberculosis en municipios del Área Metropolitana de Buenos Aires, Argentina. Salud Colect 2012; 8: 65-76.

  7. Gutiérrez JB, Ruiz P, Casal M. Resistencias a fármacos en Mycobacterium. Rev Esp Quimioter 2013; 26: 332-336.

  8. Singh A, Prasad R, Balasubramanian V, Gupta N, Gupta P. Prevalence of adverse drug reaction with first-line drugs among patients treated for pulmonary tuberculosis. Clin Epidemiol Glob Health 2015; 3: 80-90. https://doi. org/10.1016/j.cegh.2015.10.005.

  9. Bradley NJ, Barnett NE. Terapia antimicrobiana en pediatría. 23ª ed. Barcelona: Elsevier; 2017;237-244.

  10. Drew RH, Sterling TR. Antituberculous drugs: an overview. UpToDate 2019; (consultado en Enero 09, 2019). Disponible en: https://www.uptodate.com/contents/antituberculousdrugs- an-overview#H4044566

  11. Elguera FF, Juárez MG. Síndrome DRESS durante tratamiento antituberculoso. Rev Soc Peru Med Interna 2011; 24: 207-211. https://doi.org/10.36393/spmi.v24i4.469.

  12. Oliveira LR, Santos EN. Risk factors associated with adverse reactions to antituberculosis drugs. J Bras Pneumol 2015; 41: 77-89. doi: 10.1590/S1806-37132015000100010.

  13. Buhari GK, Keren M, Dursun AB, Güler M, Dulkar G, Kalaç N, et al. Immediate-type hypersensitivity reactions due to antituberculosis drugs: a successful readministration protocol. Ann Allergy Asthma Immunol 2015; 115: 39-44. doi: 10.1016/j.anai.2015.04.015.

  14. Sole D, Ivancevich JC, Borges MS, Coelho MA, Rosario NA, Ardusso LR, Bernd LA, Latin American Anaphylaxis Working Group. Anaphylaxis in Latin America: a report of the online Latin American survey on anaphylaxis (OLASA). Clinics 2011; 66: 943-947. doi: 10.1590/s1807- 59322011000600004.

  15. Boonyagars L, Hirunwiwatkul P, Hurst CP. CD4 count and risk of anti-tuberculosis drug-associated cutaneous reactions in HIV-infected Thai patients. Int J Tuberc Lung Dis 2017; 21: 338-344. doi: 10.5588/ijtld.16.0425.

  16. Vanker A, Rhode D. Human immunodeficiency virus and allergic disease. Clin Immunol 2009; 22: 168-172.

  17. Nunn P, Kibuga D, Gathua S, Brindle R, Imalingat A, Wasunna K, Lucas S, Gilks C, Omwega M, Were J. Cutaneous hypersensitivity reactions due to thiacetazone in HIV-1 seropositive patients treated for tuberculosis. Lancet 1991; 337: 627-30. doi: 10.1016/0140-6736(91)92447-a.

  18. Marks DJ, Dheda K, Dawson R, Ainslie G, Miller RF. Adverse events to antituberculosis therapy: influence of HIV and antiretroviral drugs. Int J STD AIDS 2009; 20: 339-45. doi: 10.1258/ijsa.2008.008361.

  19. Peter J, Choshi P, Lehloenya RJ. Drug hypersensitivity in HIV infection. Curr Opin Allergy Clin Immunol 2019; 19: 272-82. doi: 10.1097/ACI.0000000000000545.

  20. Yunihastuti E, Widhani A, Karjadi TH. Drug hypersensitivity in human immunodeficiency virus-infected patient: challenging diagnosis and management. Asia Pac Allergy 2014; 4: 54-67. doi: 10.5415/apallergy.2014.4.1.54.

  21. Canadian Lung Association, Canadian Thoracic Society, Public Health Agency of Canada, Centre for Communicable Diseases and Infection Control. Canadian tuberculosis standards. Chapter 5. Treatment of tuberculosis disease. 7a ed. Canada: 2014.

  22. Bavbek S, Yılmaz İ, Aydın Ö, Ozdemir SK. Pyrazinamideinduced anaphylaxis: diagnosed by skin test and successful desensitization. Int Arch Allergy Immunol 2012; 157: 209- 212. doi: 10.1159/000327537.

  23. Crook MJ. Isoniazid-induced anaphylaxis. J Clin Pharmacol 2003; 43: 545-546.

  24. Yee D, Valiquette C, Pelletier M, Parisien I, Rocher I, Menzies D. Incidence of serious side effects from first-line antituberculosis drugs among patients treated for active tuberculosis. Am J Respir Crit Care Med 2003; 167: 1472- 1477. doi: 10.1164/rccm.200206-626OC.

  25. Tan WC, Ong CK, Kang SC, Razak MA. Two years review of cutaneous adverse drug reaction from first line antituberculous drugs. Med J Malaysia 2007; 62: 143-146.

  26. Kobashi Y, Abe T, Shigeto E, Yano S, Kuraoka T, Oka M. Desensitization therapy for allergic reactions to antituberculous drugs. Intern Med 2010; 49: 2297-301. doi: 10.2169/ internalmedicine.49.3590.

  27. Thong BY, Chia FL, Tan SC, Tan TC, Leong KP, Tan JW, Tang CY, Hou JF, Chan GY, Chng HH. A retrospective study on sequential desensitization-rechallenge for antituberculosis drug allergy. Asia Pac Allergy 2014; 4: 156-63. doi: 10.5415/ apallergy.2014.4.3.156.

  28. Kura MM, Hira SK. Reintroducing antituberculosis therapy after Stevens-Johnson syndrome in human immunodeficiency virus infected patients with tuberculosis: role of desensitization. Int J Dermatol 2001; 40: 481-484. doi: 10.1046/j.1365-4362.2001.01173-7.x.




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