Korean J Gastroenterol.  2016 May;67(5):267-271. 10.4166/kjg.2016.67.5.267.

Concomitant Drug Reaction with Eosinophilia and Systemic Symptom Syndrome from Ethambutol and Autoimmune Hepatitis from Isoniazid

• Choi JH
• Heo NY
• Park SH
• Park CS
• Jo KM
• Kim WG
• Nam KH

• KMID: 2164335
• DOI: http://doi.org/10.4166/kjg.2016.67.5.267

Abstract

Anti-tuberculosis drugs can produce levels of hepatotoxicity ranging from mild elevation of aminotransferase to severe acute hepatitis. A few cases of drug-induced autoimmune hepatitis or the drug reaction with eosinophilia and systemic symptom (DRESS) syndrome by anti-tuberculosis medications have been reported. However, concomitant occurrence of these two disorders has not been reported. Here, we present a case of severe acute hepatitis with DRESS syndrome and autoimmune hepatitis resulting from primary standard anti-tuberculosis drugs. Both conditions were successfully treated with a systemic steroid regimen.

Keyword

Drug hypersensitivity syndrome; Hepatitis, autoimmune; Antitubercular agents

MeSH Terms

Antitubercular Agents
Drug Hypersensitivity Syndrome
Eosinophilia*
Ethambutol*
Hepatitis
Hepatitis, Autoimmune*
Isoniazid*
Antitubercular Agents
Ethambutol
Isoniazid

Figure

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  Fig. 1. The patient developed an erythematous facial edema (A) and generalized maculopapular skin rash (B).

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  Fig. 2. Liver biopsy showed interface hepatitis (red arrows) (H&E, ×100; A), and lympho-dominant infiltration with eosinophil (blue arrows) and plasma cell (green arrow) in portal tract (H&E, ×200; B). (C) Some lobular hepatocytes showed the rosette formation (blue arrows) (H&E, ×200).

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  Fig. 3. The treatment flow during the desensitization for the primary anti-tuberculosis drugs. INH, isoniazid; ETB, ethambutol; RIF, rifampin; PZA, pyrazinamide; Lfx, levofloxacin; Cs, cycloserine; Pto, prothionamide; Pd, prednisolone.

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  Fig. 4. The level of alanine aminotransferase according to the anti-tuberculosis medications and prednisolone administration. Lfx, levofloxacin; Cs, cycloserine; Pto, prothionamide; INH, isoniazid; ETB, ethambutol; RIF, rifampin; PZA, pyrazinamide; HERZ, isoniazid, ethambutol, rifiampin, pyrazinamide; Pd, prednisolone.

Reference

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