Management of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome in a female Indonesian with pulmonary tuberculosis: A rare case report

Background: Anti-tuberculosis drugs (ATD) induced DRESS syndrome is rarely reported, and its diagnosis and management are very challenging. Case presentation: A 33-year-old woman presented with fever, maculopapular rashes, hypereosinophilia, and hepatic involvement, which occurred 4 weeks after a fixed-dose combination of first-line ATD containing rifampicin, isoniazid, pyrazinamide, and ethambutol. The patient's condition improved after the withdrawal of the drugs and administration of systemic steroids. Furthermore, active pulmonary tuberculosis was treated with second-line ATD containing streptomycin, levofloxacin, and ethambutol with no adverse reaction. Discussion: Early identification of the causal drug for ATD-induced DRESS syndrome is essential, and it helps to facilitate the treatment process. In some cases, the change from first-line ATD to second-line in pulmonary tuberculosis patients with the syndrome can be considered after recovery with strict follow-up. Furthermore, the administration of systemic corticosteroids for tuberculosis treatment is still debatable, but it had positive effects in this study. Conclusion: Early recognition and withdrawal of all suspected drugs are crucial in managing DRESS because the delayed diagnosis can be life-threatening. The administration of systemic steroids is effective against DRESS in pulmonary tuberculosis infection.