ethionamide and Skin-Diseases

Topics: Acne Vulgaris; Adult; Amikacin; Antitubercular Agents; Drug Hypersensitivity; Ethambutol; Ethionamide; Female; Humans; Isoniazid; Male; Middle Aged; Pellagra; Pigmentation Disorders; Prothionamide; Pyrazinamide; Rifampin; Skin Diseases; Streptomycin; Thioacetazone

Isoniazid and ethionamide are important first- and second-line anti-TB drugs (FLDs and SLDs), respectively. Ethionamide is a structural analogue of isoniazid and the two drugs share other similarities, including their metabolism, therapeutic targets, hepato-toxicity patterns and drug resistance. As a result, there has always been concern about possible cross-reactivity between them.. Among 69 patients with drug rash with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) to FLDs, FLDs were stopped and SLDs added when the skin and laboratory parameters had settled. This was followed by sequential and additive rechallenge with FLDs. We report 25 consecutive cases that developed confirmed cutaneous adverse drug reactions (CADRs) to isoniazid or ethionamide used as FLD and SLD, respectively.. Sixty-nine participants who developed CADRs on FLDs were enrolled in the study. Twenty developed a rechallenge reaction to isoniazid and five reacted to ethionamide. Four of the 20 isoniazid cases were patch test positive, 3/20 were skin prick test positive and 13/20 reacted to oral rechallenge. All seven cases that were patch and skin prick test positive were associated with systemic reactions. Twenty of the 25 cases had DRESS and 5 had SJS/TEN. Twenty-three of the 25 cases with rechallenge reactions were HIV infected. Importantly, none of the cases that reacted to ethionamide during the rechallenge reacted to isoniazid and none who subsequently reacted to isoniazid reacted to ethionamide.. Our findings strongly suggest that the risk of cross-reactivity of isoniazid and ethionamide in DRESS syndrome and SJS/TEN is low. These findings have implications for clinical management.

Topics: Adolescent; Adult; Antitubercular Agents; Drug Interactions; Drug-Related Side Effects and Adverse Reactions; Ethionamide; Female; Humans; Isoniazid; Male; Skin Diseases; Young Adult

Topics: Aged; Amides; Antitubercular Agents; Chemical and Drug Induced Liver Injury; Ethionamide; Gastrointestinal Diseases; Humans; Isonicotinic Acids; Liver Function Tests; Male; Middle Aged; Nervous System Diseases; Skin Diseases; Tuberculosis, Pulmonary

The incidence and pattern of extrathoracic tuberculosis in the Siberian and Far Eastern areas are analyzed. The statements are illustrated by two clinical cases.

Topics: Adult; Antitubercular Agents; Catchment Area, Health; Ethionamide; Female; Humans; Male; Middle Aged; Mycobacterium Infections; Russia; Skin Diseases; Tuberculosis

Drug hepatitis occurred in 0-32 per cent of 7492 patients receiving antituberculous therapy, while the overall incidence of drug reactions was estimated at 9 per cent. PAS was the most common cause of drug hepatitis among the 38 patients analysed. The clinical, biochemical and haematological picture of antituberculous drug hepatitis was found to be fairly uniform. However, the patients with definite PAS hepatitis had lower SGOT values than those in whom there was uncertainty whether PAS or INH was implicated. Premonitory symptoms were present in all but four patients before the onset of jaundice. One or more of the features associated with dry hypersensitivity reactions, such as fever, rashes, lymphadenopathy, arthralgia, leucocytosis, eosinophilia and atypical monocytes were present in 89 per cent of cases so that confusion with viral hepatitis seldom arose. Sensitization time was less than three months in all except three patients, who were considered to be suffering from viral hepatitis. While no patients with PAS hepatitis died, the overall mortality was 17 per cent. A review of the literature stresses the frequency of asymptomatic elevations of SGOT, the value of clinical surveillance during the early months of therapy and the importance of stopping all therapy immediately warning symptoms appear.

Topics: Aminosalicylic Acids; Antitubercular Agents; Chemical and Drug Induced Liver Injury; Drug Hypersensitivity; Ethambutol; Ethionamide; Female; Gastrointestinal Diseases; Humans; Isoniazid; Jaundice; Lymphatic Diseases; Male; Pyrazinamide; Skin Diseases; Streptomycin; Thioacetazone; Tuberculosis, Pulmonary