Multiple drug hypersensitivity reactions to anti-tuberculosis drugs: five cases in HIV-infected patients.

BACKGROUND: The paucity of effective anti-tuberculosis drugs often justifies rechallenge with first-line drugs following adverse drug reactions (ADR) to eliminate the offending drug from the regimen. Rechallenge is usually performed under cover of drugs the patient has not been exposed to previously. The occurrence of hypersensitivity reactions to both the first-line and cover drugs poses a therapeutic dilemma and makes it difficult to identify the offending drug(s). OBJECTIVE: To characterise multiple drug hypersensitivity (MDH) in five human immunodeficiency virus (HIV) infected patients with previous tuberculosis (TB) associated ADR. DESIGN: The series is part of an ongoing randomised controlled trial assessing rechallenge dosing following TB-associated cutaneous ADR. RESULTS: The MDH was secondary to both first- and second-line anti-tuberculosis drugs. Itch, oedema, eosinophilia and fever were the most common features of MDH. Acute peripheral neuropathy associated with ethionamide, streptomycin (SM) and/or ofloxacin (OFX), to our knowledge not previously described in relation to MDH and these drugs, occurred in two patients. SM and OFX were associated with the most reactions. One patient had morphologically different reactions, namely Stevens Johnson syndrome/toxic epidermal necrolysis overlap and drug hypersensitivity syndrome, respectively to isoniazid and SM. CONCLUSION: In a description of MDH in five HIV-TB co-infected patients, including acute peripheral neuropathy, SM and OFX were the most common offending drugs.