Abstract:
BACKGROUND: Patients suffering from drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome caused by first-line antituberculous drugs often need to be re-treated rapidly. Patch tests prior to the re-introduction of antituberculosis drugs are rarely performed. OBJECTIVES: We aim to highlight those drugs most often involved in DRESS from antituberculosis drugs, illustrate the potential value of patch tests to identify these culprit(s), and provide insights in how to rapidly re-treat these patients. METHODS: A detailed description of the work-up of two illustrative patients, together with a literature review of similar cases, is provided. RESULTS: All first-line antituberculosis drugs may cause DRESS syndrome, but rifampicin and isoniazid are most frequently involved. Patch tests can be performed sooner than usually advised in the context of DRESS syndrome and potentially in lower test concentrations, but false-negative results are possible. Sequential re-introduction of patch-test negative drugs is feasible, although the dose and order of drugs to be re-administered, as well as the use of concomitant systemic corticosteroids, remains a matter of debate. CONCLUSION: Patch tests in the context of DRESS syndrome caused by antituberculous drugs, despite their shortcomings, may potentially guide rapid re-treatment of these patients. This article is protected by copyright. All rights reserved.
