Pyrazinamide Case Study

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An Unusual Case of Pyrazinamide Induced Erythema Multiforme in a Patient of Tuberculous Meningitis: A Case Report

Dr. Haiya J. Sheth1, Dr. Aarti N. Shah2, Dr. Supriya D. Malhotra3, Dr. Pankaj R. Patel4, 1First year Pharmacology Resident; 2Ex. Assistant Professor, Department of Dermatology; 3Professor & Head, Department of Pharmacology; 4Professor of Orthopaedics, Dean; Smt. N.H.L. Municipal Medical College, V.S.General Hospital, Ellisbridge, Ahmedabad-380006, Gujarat, India
Abstract: Erythema Multiforme (EM) is a skin condition having various aetiologies including drugs. Pyrazinamide, one of the 1st line Antitubercular drugs (AKT) is known to cause various adverse effects. However, reports of Pyrazinamide induced EM are rare. In the below
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They usually begin after 4-6 weeks of treatment. They need to be recognized early and the physician shout be watchful once the patient commences AKT.
Key Words: Erythema Multiforme, AKT, Pyrazinamide, Rechallenge.
Author for correspondence: Dr. Supriya D. Malhotra, Professor & Head, Department of Pharmacology,
Smt. N. H. L Municipal Medical College, Ellisbridge, Ahmedabad-380006.INDIA. e- mail:
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According to the study done by Gillani et al, AKT drugs account for almost 7.8% of cutaneous ADRs [5]. This cutaneous reaction in our case report occurred within 2 months of starting the offending drug. These findings are similar to a study done by Dua et al which reported the same duration [6]. However, incidence of Pyrazinamide induced EM is extremely rare.
EM is a skin condition with varying severity. As per the article by Dr. Oakley et al, the lesions are first seen on the backs of hands and/or tops of feet, and then spread along the limbs towards the trunk [7]. Here, the patient had lesions on his feet, gradually spreading towards the trunk. The initial lesions are sharply demarcated, round, red/pink and flat (macules), which become raised (papules/palpable) and gradually enlarge to form plaques (flat raised patches) up to several centimetres in diameter [8]. Here; multiple, well defined, raised erythematous plaques with central necrotic area (targetoid lesions) were observed

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