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. Case summary: 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. Conclusion: DRESS syndrome induced by anti-TB drugs developed in a 25-year-old woman with moxifloxacin-related subsequent AGEP.


Author Details

Authors

• Hyunah Kim¹
• Eun Sook Bang²
• Seung-Kwan Lim³
• Jae Myeong Lee⁴

Departments

• ¹ College of Pharmacy, Sookmyung Women’s University, Seoul,
• ² Department of Pharmacy,
• ³ Division of Infectious Diseases, Department of Internal Medicine, and
• ⁴ Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea

Address

Jae Myeong Lee, MD
Department of Surgery, Ajou University School of Medicine
Chief of Surgical Intensive Care Unit, Ajou University Hospital
164 World Cup-ro, Yeongtong-gu,
Suwon, 443-380, Republic of Korea
Email: [email protected]

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