[A case of tuberculous meningitis complicated with multiple drug hypersensitivity to antituberculosis agents].
Multiple drug hypersensitivity (MDH) is an allergy to two or more chemically unrelated drugs. We present a case of MDH caused by antituberculosis agents during the treatment of tuberculous meningitis (TBM). A 64-year-old man without a history of drug allergy developed fever and severe headache. Examination of cerebrospinal fluid showed lymphocytosis, a low glucose level, and a high ADA activity, suggestive of TBM. The patient was treated with isoniazid, rifampicin, pyrazinamide, and ethambutol, and his symptoms resolved quickly. However, 20 days after the initiation of therapy, he developed remittent fever without mucocutaneous lesions. A drug-induced lymphocyte stimulation test was positive for isoniazid, rifampicin, and pyrazinamide, which was consistent with a diagnosis of MDH. All the antituberculosis drugs were replaced with levofloxacin and ethionamide, both of which have excellent cerebrospinal fluid penetration, and the fever subsided. The patient made a full recovery from TBM. Because standard antituberculosis regimens include three or four antituberculosis drugs, it is difficult to determine the culprit drug when hypersensitivity occurs. Moreover, there can be multiple causative drugs as illustrated by the present case. During a time-consuming desensitization therapy, TBM could flare up, leading to permanent neurological damage. Thus, treatment with suitable alternative drugs should be started immediately.
Department of Neurology, Seirei Mikatahara General Hospital.
Motomi
M
Arai
D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000209:etiology*; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000008:administration & dosage / Q000009:adverse effects; D005000:Ethionamide / Q000008:administration & dosage*; D006801:Humans; D007159:Immunologic Tests / Q000379:methods; D007538:Isoniazid / Q000008:administration & dosage / Q000009:adverse effects; D064704:Levofloxacin / Q000008:administration & dosage*; D008213:Lymphocyte Activation / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011718:Pyrazinamide / Q000008:administration & dosage / Q000009:adverse effects; D012293:Rifampin / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000188:drug therapy*
D000995:Antitubercular Agents; D011718:Pyrazinamide; D064704:Levofloxacin; D004977:Ethambutol; D005000:Ethionamide; D007538:Isoniazid; D012293:Rifampin