Reactions Weekly | 2021
Pyrazinamide/rifampicin
Abstract
Stevens-Johnson syndrome: case report A 55-year-old woman developed Stevens-Johnson syndrome (SJS) during empiric antitubercular treatment (ATT) with rifampicin and pyrazinamide. The woman, who had a history of hypertension and hypothyroidism, presented due to shortness of breath, bilateral pedal oedema and cough associated with fever. She was diagnosed to have pericardial effusion. Despite unspecified diuretic use, pericardial effusion persisted, and pericardiocentesis was performed at outside facility. Thereafter, she started receiving empiric antitubercular treatment with rifampicin and pyrazinamide. Two weeks after treatment initiation, she developed multiple macular erythematous lesions over the face, proximal upper limbs and anterior and posterior trunk with oral ulcers and dyspnoea. She presented to current facility in this situation. On examination, she had pulsus paradoxus. An electrocardiogram showed electrical alternans. Repeat echocardiogram showed large pericardial effusion with tamponade. She underwent repeat pericardiocentesis and an investigative profile showed the presence of antinuclear antibodies and autoimmune etiology. Dermatologist consultation was taken for skin lesions, and skin biopsy specimen confirmed SJS secondary to the ATT. It was considered that the first episode of pericardial effusion could be autoimmune or hypothyroidism, and recurrent pericardial effusion was due to hypoalbuminaemia and hypothyroidism aggravating the underlying autoimmune pericarditis. The woman’s ATT was therefore discontinued. She was treated with unspecified steroids for SJS and autoimmune pericarditis resulting in gradual disappearance of lesions. One month after the second pericardiocentesis, a repeat echocardiogram showed mild pericardial effusion without tamponade. After correcting hypoalbuminaemia, her pericardial effusion was decreased.