148) A 55 year old nurse has recently been exposed to an in-patient with active Tuberculosis about 2 months ago. Her tuberculin skin test was negative a year ago however; the skin test reveals an 12 mm induration at this time. A chest x-ray is normal. She denies any cough or fever or weightloss. A comprehensive metabolic panel is within normal limits. She is started on Isoniazid for the treatment of latent tuberculosis. Two weeks after the therapy, patient develops edema in the face and neck, maculopapular rash, lymphadenopathy, asthenia, and a fever of 38°C. Laboratory tests reveal a WBC count 20k/µl with a differential showing neutrophils of 50%, eosinophils of 30% and lymphocytes 20%. The most appropriate next step in management:
A) Start antifungal therapy
B) Discontinue Isoniazid and re-administer after de-sensitization
C) Discontinue Isoniazid and administer Rifampin for four months
D) Start Metronidazole
E) Change to multi-drug therapy, Isoniazid , Pyrazinamide, Rifampin and Ethambutol
a
c
best answer is c
dr.Red can you please explain this question
Hypersensitivity syndrome from isoniazid.
http://onlinelibrary.wiley.com/doi/10.1034/j.1398-9995.1999.00161.x/full
The culprit drug has to be stopped, and corticosteroid treatment is often given at the acute stage. The treatment with steroids has been shown to be effective
C
drug induced SLE…
C