Antitubercular medications and levetiracetam-induced symmetric drug-related intertriginous and flexural exanthema

Abstract

Symmetric drug-related intertriginous and flexural exanthema (SDRIFE) is a rare, distinctive cutaneous adverse reaction associated with various medications. Here, we present the case of a 48-year-old male, admitted with complaints of slurring of speech with a deviation of face with abnormal movements and posturing of hands and limbs and loss of consciousness for about 15 min. Magnetic resonance imaging (MRI) brain with angiography was done which was suggestive of a ring-enhancing lesion with perilesional edema hinting toward the possibility of tuberculoma. A contrast MRI brain was done which was suggestive of leptomeningeal and pachymeningeal left frontal region with perilesional edema suggestive of tuberculoma so the patient was started on antitubercular therapy and dexamethasone and levetiracetam. The patient developed redness over the lower abdomen which gradually progressed to involve the lower back, bilateral axilla, and upper back. Potential suspected drugs such as antitubercular therapy and levetiracetam were stopped and the patient improved. The patient was started on another antiepileptic injection lacosamide. Antitubercular therapy was started again, on starting isoniazid 75 mg the patient started developing itching again, which was managed by giving antihistaminic. This case report highlights the importance of recognizing and managing SDRIFE as a potential complication of combination drug therapy and the need for vigilant monitoring of patients receiving such medications.