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Varghese AM, Kandra N, Uppala PK, Vangoori Y, Butti L, Masapogu S, Uttaravalli U, Somarouthu VS, Balijepalli MK. Anti-tubercular therapy (ATT) induced exfoliative dermatitis-A case series. Indian J Tuberc 2023; 70:253-257. [PMID: 37100585 DOI: 10.1016/j.ijtb.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/12/2022] [Indexed: 04/28/2023]
Abstract
Tuberculosis is a serious contagious disease mainly affecting the lungs and is common in the developing countries. The essential component of all antitubercular regimens include Isoniazid, pyrazinamide as first-line drugs. A serious cutaneous adverse drug reaction namely exfoliative dermatitis (erythroderma) is associated with isoniazid use though uncommon but is common among pyrazinamide users. Here we report 3 cases of tuberculosis patients on antitubercular therapy (ATT) for 8 weeks, came to hospital OP (outpatient) with severe generalized redness and scaling with itching distributed all over the body and trunk. Immediately ATT was discontinued and all the three patients were administered antihistaminic and corticosteroid. The patients recovered within 3 weeks. To confirm ATT induced erythroderma and narrow down the offending agents, sequential rechallenge with ATT was done and again these patients had similar lesions erupt all over the body only with isoniazid and pyrazinamide. Antihistamine, steroids were started and the symptoms resolved and completely recovered within 3 weeks. Prompt withdrawal of the culprit drug along with appropriate medications and supportive measures is necessary for good prognosis. Physicians must be judicious while prescribing ATT especially, isoniazid and pyrazinamide as these can precipitate fatal cutaneous adverse reactions. Strict vigilance may help in early detection of this type ADR and timely management.
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Affiliation(s)
- Anjaly Mary Varghese
- Dept. of Pharmacology, Santhiram Medical College & General Hospital, Nandyal, Kurnool, Andhra Pradesh, India
| | - Nagavishnu Kandra
- Dept. of Pharmacology, Santhiram Medical College & General Hospital, Nandyal, Kurnool, Andhra Pradesh, India
| | - Praveen Kumar Uppala
- (Employee ID - IPC - 291), NCC-PvPI, Indian Pharmacopeia Commission, Ghaziabad, India.
| | - Yakaiah Vangoori
- Dept. of Pharmacology, Santhiram Medical College & General Hospital, Nandyal, Kurnool, Andhra Pradesh, India
| | - Lavanya Butti
- Dept. of Clinical Pharmacy, Santhiram Medical College & General Hospital, Nandyal, Kurnool, Andhra Pradesh, India
| | - Swapna Masapogu
- Assistant Professor, Dept. of Pharmacy Practice, Santhiram College of Pharmacy, Nandyal, Kurnool, Andhra Pradesh, India
| | - Upendrarao Uttaravalli
- Dept. of Pharmaceutical Analysis, Sri Sivani College of Pharmacy, Srikakulam, Andhra Pradesh, India
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George S, Deepthi P, Sanker A, Asokan N. A cross-sectional study of adverse cutaneous drug reactions with special reference to reaction time. MULLER JOURNAL OF MEDICAL SCIENCES AND RESEARCH 2022. [DOI: 10.4103/mjmsr.mjmsr_49_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Ni J, Wang H, Wei X, Shen K, Sha Y, Dong Y, Shu Y, Wan X, Cheng J, Wang F, Liu Y. Isoniazid causes heart looping disorder in zebrafish embryos by the induction of oxidative stress. BMC Pharmacol Toxicol 2020; 21:22. [PMID: 32178728 PMCID: PMC7076990 DOI: 10.1186/s40360-020-0399-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 02/27/2020] [Indexed: 12/14/2022] Open
Abstract
Background The cardiotoxicity of isoniazid on zebrafish embryos and its underlying mechanism is unclear. Methods Here, we exposed zebrafish embryos at 4 h post-fertilization to different levels of isoniazid and recorded the morphology and number of malformed and dead embryos under the microscope. Results The high concentration of isoniazid group showed more malformed and dead embryos than the low concentration of isoniazid group and control group. The morphology of the heart and its alteration were visualized using transgenic zebrafish (cmlc2: GFP) and confirmed by in situ hybridization. The negative effects of isoniazid on the developing heart were characterized by lower heart rate and more heart looping disorders. Mechanistically, PCR showed decreased expression of heart-specific transcription factors when exposed to isoniazid. Oxidative stress was induced by isoniazid in cardiomyocytes, mediated by decreased activities of catalase and superoxide dismutase, which were rescued by scavengers of reactive oxygen species. Conclusion In conclusion, this study demonstrated that isoniazid led to heart looping disturbance by the downregulation of cardiac-specific transcription factors and induction of cardiomyocyte apoptosis.
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Affiliation(s)
- Jie Ni
- Department of Emergency, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China
| | - Hongye Wang
- The First Clinical Medical School, Nanjing Medical University, Nanjing, China
| | - Xiyi Wei
- The First Clinical Medical School, Nanjing Medical University, Nanjing, China.,Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kangjie Shen
- The First Clinical Medical School, Nanjing Medical University, Nanjing, China
| | - Yeqin Sha
- The First Clinical Medical School, Nanjing Medical University, Nanjing, China
| | - Yuxiang Dong
- The First Clinical Medical School, Nanjing Medical University, Nanjing, China
| | - Yimei Shu
- The First Clinical Medical School, Nanjing Medical University, Nanjing, China
| | - Xiaojie Wan
- Clinical School of Imaging, Nanjing Medical University, Nanjing, China
| | - Jingwen Cheng
- The Medical School of Pediatrics, Nanjing Medical University, Nanjing, China
| | - Fang Wang
- Department of Emergency, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China.
| | - Yihai Liu
- Department of Cardiology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China.
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Katare A, Arora P, Sardana K, Malhotra P. Lichenoid drug reaction due to anti-tubercular therapy presenting as erythroderma. Dermatol Ther 2019; 33:e13169. [PMID: 31747108 DOI: 10.1111/dth.13169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/10/2019] [Accepted: 11/18/2019] [Indexed: 11/30/2022]
Abstract
First-line anti-tubercular therapy (ATT) is very effective in management of tuberculosis and is usually well tolerated. Varied spectrum of cutaneous adverse drug reactions is associated with ATT, of which lichenoid drug eruption (LDR) constitutes approximately 10% of the cases. However, LDR presenting as erythroderma is very rare. Here, we report a case of exfoliative dermatitis secondary to LDR which developed after 5 months of ATT.
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Affiliation(s)
- Anusha Katare
- Department of Dermatology, PGIMER Dr RML Hospital, New Delhi, India
| | - Pooja Arora
- Department of Dermatology, PGIMER Dr RML Hospital, New Delhi, India
| | - Kabir Sardana
- Department of Dermatology, PGIMER Dr RML Hospital, New Delhi, India
| | - Purnima Malhotra
- Department of Pathology, PGIMER Dr RML Hospital, New Delhi, India
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