Anti-tubercular therapy-induced maculopapular exanthema – A case series

Abstract

Tuberculosis (TB) is the most common, treatable and curable chronic infectious disease rampant in the developing countries. Anti-TB medications may be associated with several adverse effects including cutaneous reactions. Maculopapular exanthemas (MPE) are small cutaneous reddish macules and papules. Here we present 3 tuberculosis cases, treated with antitubercular therapy (ATT) enrolled in the outpatient department of Dermatology. Chief complaints were generalized rashes with itching and redness over the body. ATT was instantly stopped. Antihistamine, corticosteroid and topical emollients were administered to all the three patients. After 3 weeks, these patients recovered (dechallenge positive). For confirmation of ATT induced maculopapular rashes and to pin down the culprit drug, sequential rechallenge with individual ATT components was performed. Similar cutaneous eruptions were observed over the body with pyrazinamide in one case and with rifampicin in the other two cases (rechallenge positive). Symptoms of rechallenge resolved with antihistamine, steroids in 10 days. To restart ATT safely, re-challenge remains the best option and continue with alternative efficient anti-TB drugs as TB requires extensive therapy. Close, vigilant monitoring of ATT patients especially those on rifampicin and pyrazinamide must be done as these may precipitate MPE. Strict pharmacovigilance measures helps in early detection, timely management and prevent ATT induced ADRs. This is pivotal to promote safer drug utilization and help to achieve better prognostic outcomes.