The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Pyrazinamide-Induced Urticaria and Angioedema: a Case Report

경구 유발시험으로 진단한 Pyrazinamide 유발 두드러기와 혈관부종: 증례 보고

  • Kang, Yewon (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kang, Jieun (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Kyoungmin (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jeong, Dae hyun (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Noh, Soomin (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Seo, Bomi (Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Tae-Bum (Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine)
  • 강예원 (울산대학교 의과대학 서울아산병원 내과) ;
  • 강지은 (울산대학교 의과대학 서울아산병원 내과) ;
  • 이경민 (울산대학교 의과대학 서울아산병원 내과) ;
  • 정대현 (울산대학교 의과대학 서울아산병원 내과) ;
  • 노수민 (울산대학교 의과대학 서울아산병원 내과) ;
  • 서보미 (울산대학교 의과대학 서울아산병원 알레르기내과) ;
  • 김태범 (울산대학교 의과대학 서울아산병원 알레르기내과)
  • Received : 2017.05.24
  • Accepted : 2017.08.09
  • Published : 2018.06.01
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Abstract

Pyrazinamide (PZA) is an anti-tuberculosis drug and an essential component of the standard four-drug regimen for tuberculosis. Here, we report a case of immediate angioedema secondary to PZA administration intended for pulmonary tuberculosis treatment. A previously healthy 48-year-old woman was diagnosed with pulmonary tuberculosis and tuberculous lymphadenitis. Thirty minutes after taking the first dose of isoniazid, rifampicin, pyrazinamide, and ethambutol, the patient developed facial edema, generalized rash, and dizziness. An oral provocation test was performed on the four drugs, and 1,000 mg pyrazinamide showed a positive result characterized by 50 minutes of urticaria, angioedema, and hypotension. As the prevalence of tuberculosis increases, prescriptions for anti-tuberculosis drugs may increase as well. Clinicians should be aware of the possibility of immediate hypersensitivity as well as delayed hypersensitivity to anti-tuberculosis drugs.

항결핵제에 의한 즉시형 과민반응은 드물게 발생하지만, 국내의 결핵 유병률이 높고 항결핵제가 자주 처방되는 약물임을 고려할 때, 치료시 주의를 기울이는 것이 필요하겠다.

Keywords

References

  1. Centers for Disease Control and Prevention (CDC); American Thoracic Society. Update: adverse event data and revised American Thoracic Society/CDC recommendations against the use of rifampin and pyrazinamide for treatment of latent tuberculosis infection-United States, 2003. MMWR. Morb Mortal Wkly Rep 2003;52:735-739.
  2. Buhari GK, Keren M, Dursun AB, et al. Immediate-type hypersensitivity reactions due to antituberculosis drugs: a successful readministration protocol. Ann Allergy Asthma Immunol 2015;115:39-44. https://doi.org/10.1016/j.anai.2015.04.015
  3. Korea Centers for Disease Control & Prevention. Annual Report on the Notified Tuberculosis in Korea, 2014. [Internet]. Cheongju (KR): KCDC, c2017 [cited 2017 May 17]. Available from: http://www.cdc.go.kr/CDC/info/CdcKrInfo0302.jsp?menuIds=HOME001-MNU1132-MNU1138-MNU0038fid=32q_type=q_value=cid=20017pageNum=&fid=32&q_type=&q_value=&cid=64356&pageNum=1.
  4. Schaberg T, Rebhan K, Lode H. Risk factors for side-effects of isoniazid, rifampin and pyrazinamide in patients hospitalized for pulmonary tuberculosis. Eur Respir J 1996;9:2026-2030. https://doi.org/10.1183/09031936.96.09102026
  5. Yee D, Valiquette C, Pelletier M, Parisien I, Rocher I, Menzies D. Incidence of serious side effects from first-line antituberculosis drugs among patients treated for active tuberculosis. Am J Respir Crit Care Med 2003;167:1472-1477. https://doi.org/10.1164/rccm.200206-626OC
  6. Kim SH, Lee BH, Lee KD, et al. The prevalence of adverse drug reactions to a short course anti-tuberculosis regimen. Korean J Med 2007;73:496-502.
  7. Lehloenya RJ, Dheda K. Cutaneous adverse drug reactions to anti-tuberculosis drugs: state of the art and into the future. Expert Rev Anti Infect Ther 2012;10:475-486. https://doi.org/10.1586/eri.12.13
  8. Tan W, Ong C, Kang SC, Razak MA. Two years review of cutaneous adverse drug reaction from first line anti-tuberculous drugs. Med J Malaysia 2007;62:143-146.
  9. Zhang Y, Mitchison D. The curious characteristics of pyrazinamide: a review. Int J Tuberc Lung Dis 2003;7:6-21.
  10. Ribi C, Hauser C. Adverse reactions to pyrazinamide. Allergy 2002;57:964-965. https://doi.org/10.1034/j.1398-9995.2002.23832_9.x
  11. Bedi RS. Pyrazinamide-induced hypersensitivity reactions. Ind J Tub 1990;37:41.
  12. Bavbek S, Yilmaz I, Aydin O, Ozdemir SK. Pyrazinamideinduced anaphylaxis: diagnosed by skin test and successful desensitization. Int Arch Allergy Immunol 2012;157:209-212. https://doi.org/10.1159/000327537
  13. Cho YJ. Update on the diagnosis of drug allergy. Korean J Med 2009;76:282-290.
  14. Aberer W, Bircher A, Romano A, et al. Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations. Allergy 2003;58:854-863. https://doi.org/10.1034/j.1398-9995.2003.00279.x