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Abstract
Acute tuberculosis (TB) is a communicable disease that results from Mycobacterium tuberculosis (M.TB) infection.Although tuberculosis disease primarily impacts the lung parenchyma (pulmonary TB), this bacterium is also capable of infecting other organs (extra-pulmonary TB). Management uses a combination of several OATs over a certain period of time with treatment side effects which often become serious problems, causing patient non-compliance in taking medication. This article reports the case of a 44 year old man, who presented with multiple tense bullae on top of erythematous plaque some with crust distributed on generalized, after 2 weeks of taking OAT. Sputum examination revealed MTB detected medium, Rif Resistance Not Detected. From the chest x-ray results, it was found that there were infiltrates in the left lung field. The patient was diagnosed with a new case of pulmonary TB and bullous pemphigoid skin eruption which was suspected to be an OAT induced. The skin lesion in the form of a crusted maculo-bullous rash, based on the classification of skin lesions by the 2018 International Union Against Tuberculosis and Lung Disease (IUATLD) field guideline, is classified as grade 3 (severe). Management using the treating through method continues the administration of OAT accompanied by additional oral steroid and anti-histamine therapy, then close observation during administration of OAT. After clinical improvement, the patient will then be monitored regarding drug side effects and adverse drug reactions (ADRs) during treatment through routine monthly evaluations at the RSMH DOTS polyclinic. Adverse effects often occur during pulmonary TB treatment and affect the success rate of treatment. Only 2% of adverse drug reactions on the skin occur due to OAT when treating pulmonary TB. It is important for us to monitor ADRs to ensure safety during treatment and improve patient quality of life. Therefore, a comprehensive approach starting from providing appropriate therapy, managing side effects as well as clinical monitoring and support during treatment is very important to achieve patient recovery.
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References
- Akrout I, Tangour E, Fenniche S, Hassene H, Feki L, Greb D, et al. Ethambutol induced bullous and lichenoid skin eruptions. EurRespir J. 2011;38(Suppl 55):p4412
- Alina Rajan et al. A Case Report On Drug-Induced Bullous Pemphigoid.Int. J. of Allied Med. Sci. and Clin. Research Vol-11(2) 2023 [206-209]
- Cohen PR. Dyshidrosiform bullous pemphigoid: case reports and review. Cureus. 2020 Jan 11;12(1):e6630. doi: 10.7759/cureus.6630, PMID 32064205.
- Fla VM et.al. Adverse Drug Reactions Related to Treatment of Drug-Susceptible Tuberculosis in Brazil: A Prospective Cohort Study. Major Tropical Diseases, a section of the journal Frontiers in Tropical Disease. January 2022:Vol 2; Article 748310
- Garrido-Colmenero C, Blasco-Morente G, Martínez-Peinado C, Pérez-López I, Martínez-López A, Nogueras-Morillas P et al. Rifampicin-induced bullous pemphigoid. J American academy of dermatology. 2016;74(5):Supp:p AB222
- Grando LR, Aline T, Schmitt B. Severe cutaneous reactions to drugs in the setting of a general hospital *. 2014;89(5):758-762.
- IbnSellam A, Soualhi M, Zahraoui R, Marc K, Benamor J, Bourkadi JE, et al. A rare form of rifampicininduced skin toxicity: Bullous pemphigoid. Revue des Maladies Respiratoires. 2011;28(3):365-371
- K. Vinitha, KN Reddy, Sake S, Sirisha K, Naik T, Kumar ESJ. A Case Report on Isoniazid Induced Bullous Drug Reaction. Int j pharm pharm res. 2016;8(1): 149-154.
- Kementrian Kesehatan Republik Indonesia. Keputusan Menteri Kesehatan Republik Indonesia Nomor HK.01.07/MENKES/755/2019 tentang Pedoman Nasional Pelayanan Kedokteran Tata Laksana Tuberkulosis. Jakarta: 2019.
- Manchanda Y, Das S, Sarda A, Biswas P. Controversies in the management of cutaneous adverse drug reactions. Indian J Dermatol 2018;63:125-30
- Moro F, Fania L, Sinagra JLM, Salemme A, Di Zenzo G. Bullous pemphigoid: trigger and predisposing factors. Biomolecules. 2020;10(10):1432. doi: 10.3390/biom10101432, PMID 33050407
- National institutes of health. Adverse Durg Reaction Probability Scale (Naranjo) in drug liver injury. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. 2019
- Pradipta IS, et al. Barriers to Optimal Tuberculosis Treatment Services at Community Health Centers: A Qualitative Study From a High Prevalent Tuberculosis Country. Front Pharmacol. 2022 Mar 25;13.
- Pradipta IS,et al. Barriers and strategies to successful tuberculosis treatment in a high-burden tuberculosis setting: a qualitative study from the patient’s perspective. BMC Public Health. 2021 Dec 1;21(1).
- Singh A, Prasad R, Balasubramanian V, Gupta N, Gupta P. Prevalence of adverse drug reaction withfirst-line drugs among patients treated for pulmonary tuberculosis. ClinEpidemiol Glob Health. 2015;3(1):S80-S90
- Tiberi S, Scardigli A, Centis R, D’Ambrosio L, Muñoz-Torrico M, Salazar-Lezama MA. Classifying new anti-tuberculosis drugs: rationale and future perspectives. Int J Infect Dis. 2017; 56:181-184
- WHO. GLOBAL Tuberculosis REPORT 2023. WHO; 2023.
References
Akrout I, Tangour E, Fenniche S, Hassene H, Feki L, Greb D, et al. Ethambutol induced bullous and lichenoid skin eruptions. EurRespir J. 2011;38(Suppl 55):p4412
Alina Rajan et al. A Case Report On Drug-Induced Bullous Pemphigoid.Int. J. of Allied Med. Sci. and Clin. Research Vol-11(2) 2023 [206-209]
Cohen PR. Dyshidrosiform bullous pemphigoid: case reports and review. Cureus. 2020 Jan 11;12(1):e6630. doi: 10.7759/cureus.6630, PMID 32064205.
Fla VM et.al. Adverse Drug Reactions Related to Treatment of Drug-Susceptible Tuberculosis in Brazil: A Prospective Cohort Study. Major Tropical Diseases, a section of the journal Frontiers in Tropical Disease. January 2022:Vol 2; Article 748310
Garrido-Colmenero C, Blasco-Morente G, Martínez-Peinado C, Pérez-López I, Martínez-López A, Nogueras-Morillas P et al. Rifampicin-induced bullous pemphigoid. J American academy of dermatology. 2016;74(5):Supp:p AB222
Grando LR, Aline T, Schmitt B. Severe cutaneous reactions to drugs in the setting of a general hospital *. 2014;89(5):758-762.
IbnSellam A, Soualhi M, Zahraoui R, Marc K, Benamor J, Bourkadi JE, et al. A rare form of rifampicininduced skin toxicity: Bullous pemphigoid. Revue des Maladies Respiratoires. 2011;28(3):365-371
K. Vinitha, KN Reddy, Sake S, Sirisha K, Naik T, Kumar ESJ. A Case Report on Isoniazid Induced Bullous Drug Reaction. Int j pharm pharm res. 2016;8(1): 149-154.
Kementrian Kesehatan Republik Indonesia. Keputusan Menteri Kesehatan Republik Indonesia Nomor HK.01.07/MENKES/755/2019 tentang Pedoman Nasional Pelayanan Kedokteran Tata Laksana Tuberkulosis. Jakarta: 2019.
Manchanda Y, Das S, Sarda A, Biswas P. Controversies in the management of cutaneous adverse drug reactions. Indian J Dermatol 2018;63:125-30
Moro F, Fania L, Sinagra JLM, Salemme A, Di Zenzo G. Bullous pemphigoid: trigger and predisposing factors. Biomolecules. 2020;10(10):1432. doi: 10.3390/biom10101432, PMID 33050407
National institutes of health. Adverse Durg Reaction Probability Scale (Naranjo) in drug liver injury. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. 2019
Pradipta IS, et al. Barriers to Optimal Tuberculosis Treatment Services at Community Health Centers: A Qualitative Study From a High Prevalent Tuberculosis Country. Front Pharmacol. 2022 Mar 25;13.
Pradipta IS,et al. Barriers and strategies to successful tuberculosis treatment in a high-burden tuberculosis setting: a qualitative study from the patient’s perspective. BMC Public Health. 2021 Dec 1;21(1).
Singh A, Prasad R, Balasubramanian V, Gupta N, Gupta P. Prevalence of adverse drug reaction withfirst-line drugs among patients treated for pulmonary tuberculosis. ClinEpidemiol Glob Health. 2015;3(1):S80-S90
Tiberi S, Scardigli A, Centis R, D’Ambrosio L, Muñoz-Torrico M, Salazar-Lezama MA. Classifying new anti-tuberculosis drugs: rationale and future perspectives. Int J Infect Dis. 2017; 56:181-184
WHO. GLOBAL Tuberculosis REPORT 2023. WHO; 2023.