title: DRESS syndrome and acute generalized exanthematous pustulosis induced by antituberculosis medications and moxifloxacin: case report .
abstract: OBJECTIVE
  To report a rare case of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome caused by antituberculosis (TB) drugs, which progressed to acute generalized exanthematous pustulosis (AGEP) after moxifloxacin treatment.
  
  
  METHODS
  A 25-year-old female was hospitalized for dyspnea and dizziness. She had a history of TB and experienced rifampin-induced skin rash. She was treated for TB with moxifloxacin, isoniazid, ethambutol, and pyrazinamide. Upon admission, she had a fever of 39.2 °C, and aspartate aminotransferase (AST), alanine aminotransferase (ALT) levels, and eosinophil count increased during the first 10 days after admission. The patient had a rash all over the body with itching, pain, and a burning sensation. Diagnosis of DRESS syndrome was made. Immunoglobulin and prednisolone administration improved the DRESS symptoms. After the first DRESS syndrome diagnosis, anti-TB medications were changed to isoniazid, ethambutol, pyrazinamide, cycloserine, and streptomycin, which also caused a skin rash, itching, and elevated AST/ALT levels, and eosinophil count. Then, the anti-TB treatment was changed to cycloserine, streptomycin, ethionamide, and para-aminosalicylic acid. The rash and itching persisted and eosinophil count increased further. All TB medications were discontinued except streptomycin. Due to the flushing and a burning sensation by streptomycin at the injection site, it was replaced with moxifloxacin. The patient experienced erythematous pustules and patches on skin with desquamation, fissures, and swelling. Therefore, a diagnosis of moxifloxacin-induced AGEP was made.
  
  
  CONCLUSIONS
  DRESS syndrome induced by anti-TB drugs developed in a 25-year-old woman with moxifloxacin-related subsequent AGEP. .
authors.forename: Hyunah
authors.initials: H
authors.lastname: Kim
authors.forename: Eun Sook
authors.initials: ES
authors.lastname: Bang
authors.forename: Seung-Kwan
authors.initials: SK
authors.lastname: Lim
authors.forename: Jae Myeong
authors.initials: JM
authors.lastname: Lee
mesh_terms: D056150:Acute Generalized Exanthematous Pustulosis / Q000209:etiology* / Q000473:pathology; D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000009:adverse effects*; D018450:Disease Progression; D063926:Drug Hypersensitivity Syndrome / Q000209:etiology* / Q000473:pathology; D004804:Eosinophils / Q000378:metabolism; D005260:Female; D024841:Fluoroquinolones / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D000077266:Moxifloxacin; D011537:Pruritus / Q000209:etiology
chemical_list: D000995:Antitubercular Agents; D024841:Fluoroquinolones; D000077266:Moxifloxacin