Antituberculosis drug-induced toxicoderma: A rare but potentially severe adverse reaction: A case report

We report the case of a 52-year-old male patient with pulmonary tuberculosis who, 72 hours after initiating antituberculosis therapy, developed a severe drug-induced toxicoderma. The clinical presentation was characterized by intense pruritus, erythematous rash, eczema, and diffuse skin desquamation with a positive Nikolsky sign. Given the suspicion of a severe adverse reaction, the antituberculosis regimen was immediately discontinued, and management with fluid support and topical corticosteroids was initiated. Skin biopsy revealed a perivascular lymphoplasmacytic infiltrate, lymphocytic exocytosis, and neutrophilic aggregates, findings consistent with a reactive inflammatory process induced by drugs.

The discussion focuses on the immunological complexity of the case, which exhibited overlapping clinical and histological features between type IVc (cytotoxic) and type IVd (neutrophilic) hypersensitivity reactions, suggesting a combined form within the spectrum of toxic epidermal necrolysis (TEN) and acute generalized exanthematous pustulosis (AGEP). In addition to cutaneous involvement, the patient developed a mixed pattern of liver injury that resolved following drug withdrawal. After complete remission of the lesions was achieved, a stepwise and monitored reintroduction of the regimen was carried out, which was well tolerated.

This case underscores that early diagnosis and prompt discontinuation of the causative agent are the most critical prognostic factors in preventing fatal outcomes in drug-induced toxicodermas associated with first-line antituberculosis medications.