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Case Reports
. 2018 Apr 3:14:13.
doi: 10.1186/s13223-018-0237-x. eCollection 2018.

Immediate type hypersensitivity and late phase reaction occurred consecutively in a patient receiving ethambutol and levofloxacin

Yukihiko Kato  1   2   3 , Yu Sato  4 , Miho Nakasu  1   2 , Ryoji Tsuboi  2
Affiliations
Case Reports

Immediate type hypersensitivity and late phase reaction occurred consecutively in a patient receiving ethambutol and levofloxacin

Yukihiko Kato et al. Allergy Asthma Clin Immunol. .

Abstract

Background: We experienced a rare case of immediate type hypersensitivity and late phase reaction to anti-tubercular therapy consisting of ethambutol and levofloxacin, which occurred in close succession, giving the appearance of a single, continuous reaction to one drug.

Case presentation: The patient was a man in his 70's who began therapy consisting of isoniazide, rifampicin, and ethambutol for pulmonary tuberculosis. Since the patient had a drug eruption within several hours after the start of his treatment, his reaction to ethambutol was assessed first among the three suspected drugs using an oral challenge test. Levofloxacin, which was not among the suspected drugs, was administered with ethambutol in order to avoid drug resistance resulting from the administration of a single drug. The patient experienced pruritus within 1 h. We observed a well-defined, edematous erythema with induration, which persisted for several days after the patient received the two drugs. Next, skin tests were performed with ethambutol and levofloxacin. The skin reaction to ethambutol and levofloxacin consisted of two different types of allergic reaction, a immediate type reaction and phase reaction.

Conclusion: This is the first report of a late phase reaction and immediate type hypersensitivity occurring in quick succession in the same patient. Subsequent skin tests were able to prove the presence of these two different types of allergic reactions.

Keywords: Anti-tubercular therapy; Drug eruption; Ethambutol; Immediate type hypersensitivity; Late phase reaction.

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Figures

Fig. 1
Fig. 1
A Shows the results of the skin prick test using ethambutol, levofloxacin, and saline at 15 min, 6 h, 24 h, and 72 h after injection. B Shows the changes in the diameter of the wheal and induration/erythema over time
See this image and copyright information in PMC

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