Abstract
Pyrazinamide is primarily used in the treatment of active tuberculosis as a first line agent. Gastric adverse effects due to Pyrazinamide have been commonly reported. On the contrary, skin rash and photosensitivity as a side effect are seldom observed. We reported a case of maculopapular rash due to Pyrazinamide in a patient on anti-tuberculosis treatment (ATT) for right sacroiliac joint tuberculosis, using three questionnaire systems. The patient developed maculopapular rash on receiving combination ATT. The rash disappeared after discontinuation of the suspected drug. The patient was rechallenged with pyrazinamide, which led to reappearance of rash. The causality and severity were assessed using the Naranjo algorithm, WHO-UMC causality assessment score and Hartwig scale. In developing countries, musculoskeletal tuberculosis has a high prevalence with pyrazinamide as the first line drug. Since rare adverse effects like skin manifestations may lead to non compliance of the patient to the therapy. Hence, awareness, early detection and timely management may hold prime importance.
Keywords: Pyrazinamide, Maculopapular rash, sacro-iliac tuberculosis, Naranjo algorithm, WHO-UMC causality assessment scale, Hartwigs scale.
References
- Centers for disease control and prevention. Treatment of tuberculosis, american thoracic society,cdc, and infectious diseases society of america. Mmwr recomm rep. 2003; 52(rr-11):1-77.
- Centers for disease control and prevention. Update: adverse event data and revised american thoracic society/cdc recommen-dations against the use of rifampin and pyrazinamide for treatment of latent tuberculosis infection—united states, 2003. Mmwr morb mortal wkly rep. 2003; 52:735-9. [pubmed 12904741]
- Mehta dk, martin j, costello i, jordan b, editors. London: bmj publishing group; 2005. Bnf 50.
- Pichler wj. Delayed drug hypersensitivity reactions. Ann intern med 2003; 139:683–693.
- Hari y, frutig-schnyder k, hurni m, et al. T cell involvement in cutaneous drug eruptions. Clin exp allergy 2001; 31:1398–1408.
- Managing the revised national tuberculosis programme in your area: a training course. Module 1-4. Central tb division, directorate general of health services, ministry of health and family welfare, nirman bhavan. 2005:76–110
- Naranjo ca, busto u, sellers em, sandor p, ruiz i, roberts ea, et al. A method for estimating the probability of adverse drug reactions. Clin pharmacol ther. 1981;30:239–45.
- https://www.who-umc.org/media/2768/ standardised-case-causality assessment.pdf
- Hartwig sc, siegel j, schneider pj. Preventability and severity assessment in reporting adverse drugs reactions. Am j hosp pharm. 1992;49:2229–32.
- Magee p. Drug-induced skin disorders. In: walker r, edwards c, editors. Clinical pharmacy and therapeutics. 3rd edi. Phildelphia: churchill livingstone; 2003. Pp. 843–52.
- Corbella x, vadillo m, cabellos c, fernande-zviladrich p, rufi g "hypersensitivity hepatitis due to pyrazinamide." scand j infect dis 27 (1995): 93-4
- https://www.tbcindia.gov.in/showfile.php?lid=3245 page 75-7.
Corresponding Author
Dr. Swapnil D Patil
Vrindawan Nagar, Malegaon Road Naka, Chalisgaon, Distt Jalgaon, Maharashtra 424101
Mobile no. +918194989090, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v6i2.21
