Co-Trimoxazole Induced Severe Cutaneous Adverse Reaction: A Challenging Diagnosis
Introduction; Drug Reaction with Eosinophilia and systemic symptoms (DRESS) Syndrome is a life-threatening reaction with a mortality rate of 10-20%. Usual reaction period is 2 to 6 week after the first intake of drug. The present case is an example of late presentation of the symptoms which made the diagnosis difficult.
Clinical case: We describe a case of 51 year old male with known history of Acquired ImmunoDeficiency Syndrome (AIDS) and Tuberculosis (TB) presented with complaints of fever, generalised scaling, oedema, eosinophilia and elevated liver enzymes. The symptoms started 45 days back but was then misdiagnosed and treated as exfoliative dermatitis from a local hospital. The symptoms aggravated since 5 days and were admitted in our hospital. Drug reaction was least suspected as he has been taking the Antiretroviral (ART) and Anti-tubercular (ATT) drugs since 3 to 4 months. But later on culprit drug was identified to be Sulfamethoxazole-Trimethoprim and was soon discontinued. Significant improvement was seen with steroid, antihistamines and other topical agents.
Discussion: Timely recognition of DRESS Syndrome, prompt discontinuation of culprit drug and symptomatic management are imperative in a better prognosis. It must also be noted that the latency period can be as long as 105 days after the first intake of the drug, rather than the usual presentation period of 2-6 week.
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