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Laxminarayana Samaga, Sudheendra Rao, Javedh Shareef*


Pyrazinamide is one of the most commonly used anti tubercular drug. Adverse drug reactions such as gastritis, hyperuricemia and elevated liver enzyme levels are common with pyrazinamide. However, dermatological/skin reactions to pyrazinamide are rare/uncommon. This article finds out a dermatological manifestations/adverse drug reaction (ADR) due to pyrazinamide. Here we present a case report of male patient who developed acute onset exanthematous febrile illness caused by pyrazinamide following treatment with DOTS (Direct Observation Treatment Short course) Category -1 Anti-tubercular therapy for tubercular cervical lymphadenopathy. The patient developed fever with chills, headache, myalgia, arthralgia and itchy rash on the head, chest, trunk and thighs during the first week of DOTS Category -1 anti-tubercular regimen. The rashes and elevated enzyme levels disappeared after 3 days of stopping the anti-tubercular drugs. He was re-challenged with sequential daily dosing of isoniazid followed by rifampicin and ethambutol. Patient tolerated medications well without any fever or rashes. When he was re-challenged with pyrazinamide, rashes reappeared with febrile illness. The causality, preventability and severity were assessed using the Naranjo algorithm and Hartwig scale. Since pyrazinamide is one of the most common drug used in the treatment of tuberculosis, with the similar reports early detection and withdrawing the drug from the regimen helps in decreasing the prolonged hospital stay and healthcare cost significantly.

Keywords: Tuberculosis, Pyrazinamide, Flu like febrile illness, rechallenge, Naranjo and hartwig scales.

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