A Case of Rib Tuberculosis and Chest Wall Abscess with Multi-Drug Hypersensitivity Reactions

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dc.authorid0000-0003-3311-3338en_US
dc.authorid0000-0001-5278-0174en_US
dc.contributor.authorAkduman Alasehir, Elcin
dc.contributor.authorSariman, Nesrin
dc.contributor.authorYaman, Gorkem
dc.contributor.authorOlgac, Muge
dc.contributor.authorSaygi, Attila
dc.date.accessioned2024-07-12T21:52:12Z
dc.date.available2024-07-12T21:52:12Z
dc.date.issued2015en_US
dc.departmentMaltepe Üniversitesien_US
dc.description.abstractExtrapulmonary tuberculosis is the reactivation of the remaining latent organism which spreads during primary infection by the lymphohematogenous way. It should be considered in the differential diagnosis especially in endemic countries for tuberculosis. Tuberculosis (TB) treatment is based on the principle of the combined use of several drugs. As a result of the combination therapy there can be life threatening side effects which can lead to improper use of medications and may also cause drug resistance. In this report, we present an 85-year-old male patient desensitized due to the development of allergy against multi-drugs with rib tuberculosis and chest wall abscess to whom, culture, drug susceptibility and genotypical tests were applied. In November 2012, the patient applied to a medical center with complaints of swelling and pain under the right rib, underwent rib resection and eventually diagnosed as rib TB by histopathological examination. However, the anti-TB treatment was discontinued due to the hypersensitivity reactions in the skin and in addition to the hepatic and renal dysfunction side effects. The patient had widespread redness, rash and pruritus on the body and the laboratory findings were as follows; ALT: 114 U/L, AST: 152 U/L, ALP: 93 U/L, GGT: 26U/L, blood urea nitrogen (BUN): 26 mg/dL and creatinine: 1.7 mg/dL. After the disapperance of the complaints within 3 days of drug discontinuation, isoniazid treatment was initiated. However, the new treatment was also discontinued when the reactions reoccurred. Afterwards, the patient developed hypersensitivity reactions against the combination of streptomycin and ethambutol. The patient refused any further treatment and was discharged from the hospital. The patient was untreated for the last 5 months and admitted to our clinic with a fistulized swelling and abscess in the right chest wall. Bacteria was not detected in the acid-fast staining of the abscess material, however Mycobacterium tuberculosis was isolated from culture by MGIT (Mycobacteria Growth Incubator Tube; BBL MGIT, BD, USA) system. The spoligotyping revealed that the genotype was Haarlem 1. Major drug susceptibility testing against rifampin, streptomycin, ethambutol, isoniazid, and pyrazinamide yielded sensitivity to those drugs. Minor drug susceptibility testing against paraaminosalicylic acid, ethionamide, kanamycin, capreomycin and ofloxacin was found to be sensitive. A regimen of isoniazid 300 mg/day, ethambutol 1000 mg/day and moxifloxacin 400 mg/day was initiated. Rapid oral desensitization against isoniazid and ethambutol were repeated on two consecutive days. The patient continued antituberculosis therapy for 12 months without adverse reactions. The chest wall fistula was closed. Abscess was drained surgically. Clinical and radiological improvements were achieved. The patient remains clinically disease free and continues his regular follow ups. This case is presented to emphasize about the importance of culture and susceptibility testing in extrapulmonary tuberculosis cases and desensitization in drug hypersensitivity reactions.en_US
dc.identifier.doi10.5578/mb.9366
dc.identifier.endpage460en_US
dc.identifier.issn0374-9096
dc.identifier.issue3en_US
dc.identifier.pmid26313287en_US
dc.identifier.scopusqualityQ4en_US
dc.identifier.startpage454en_US
dc.identifier.urihttps://dx.doi.org/10.5578/mb.9366
dc.identifier.urihttps://hdl.handle.net/20.500.12415/8355
dc.identifier.volume49en_US
dc.identifier.wosWOS:000360254000015en_US
dc.identifier.wosqualityQ4en_US
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakPubMed
dc.language.isotren_US
dc.publisherANKARA MICROBIOLOGY SOCen_US
dc.relation.ispartofMIKROBIYOLOJI BULTENIen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/openAccessen_US
dc.snmzKY02930
dc.subjectMycobacterium tuberculosisen_US
dc.subjectrib tuberculosisen_US
dc.subjectabscessen_US
dc.subjecthipersensitivity reactionen_US
dc.subjectskinen_US
dc.subjectdesensitizationen_US
dc.titleA Case of Rib Tuberculosis and Chest Wall Abscess with Multi-Drug Hypersensitivity Reactionsen_US
dc.typeArticle
dspace.entity.typePublication

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