Response to Modified Antitubercular Drug Regime and Antiretroviral Therapy in a Case of HIV Infection with Disseminated Tuberculosis with Isoniazid Induced Toxic Epidermal Necrolysis

Abstract

Toxic epidermal necrolysis (TEN) is a potentially life-threatening disorder characterized by widespread erythema, necrosis, and bullous detachment of the epidermis and mucous membranes. Without proper management,TEN can cause sepsis leading to death of the patient. Though TEN is commonly drug induced, Isoniazid (INH) has been uncommonly associated with TEN. As INH is one of the first line drugs in treatment of tuberculosis, TEN induced INH needs modification of antitubercular therapy (ATT) with withdrawal of INH from the treatment regime along with other supportive treatments. Patients with HIV infection and disseminated tuberculosis need to be urgently initiated on an effective ATT on diagnosis of tuberculosis. However, if the patient develops potential life-threatening toxicity to first line antitubercular drugs like INH, an alternative effective ATT combination needs to be started as soon as the condition of the patient stabilizes as most of these patients present in advanced stage of HIV infection and this is to be followed by antiretroviral therapy (ART) as per guidelines. The present case reports the effectiveness of an ATT regime comprising Rifampicin, Pyrazinamide, Ethambutol, and Levofloxacin along with ART in situations where INH cannot be given in disseminated tuberculosis in HIV patients.

Case Report: A successful case of toxic epidermal necrolysis treated with plasmapheresis therapy

“… 12 TEN symptoms usually appear between 6 days to 14 days after taking antituberculosis therapy in tuberculosis patients. 13 , 14 Das et al reported a TEN case in an immunocompetent adult with tuberculosis, however, the patient was elderly (67-years-old). 13 The longest duration between drug administration and TEN symptoms presentation was five weeks.…”

COVID-19 infection in a HIV positive health care worker: first case report from a tertiary care hospital of North India

“…Even though the COVID-19 pandemic has rapidly spread worldwide, little is known about its impact and outcomes in immunocompromised patients. The severity and clinical outcome of many viral infections such as Respiratory syncytial virus (RSV) and influenza (seasonal and pandemic H1N1) in PLHIV patients has been described in immunocompromised and immunocompetent cases and the presentation varies from full recovery to death [ 6 ]. These studies have concluded that comorbid conditions might be responsible for the increased hospitalization and mortality in immunocompromised (PLHIV) with lower CD4 + count [ 11 ].…”