Antitubercular drug-induced lichen planus: A case study with a mini literature review

Author:

Shanmukhappa Sanjana C.1,John Winny2,Kevalramani Vineeta2,Lokeshwaran Srivatsa3,Furtado Shireen4,Nosenoor Mahesh2

Affiliation:

1. Department of Internal Medicine, Unity Hospital, Rochester, New York, United States

2. Department of Pharmacy, KLE College of Pharmacy, Bengaluru, Karnataka, India

3. Department of Interventional Pulmonology, Aster CMI Hospital, Bengaluru, Karnataka, India

4. Department of Dermatology, Aster CMI Hospital, Bengaluru, Karnataka, India

Abstract

ABSTRACT Introduction: Drug-induced lichen planus is a cutaneous adverse effect that manifests as a systemic eruption of flat-topped, erythematous, or violaceous papules resembling lichen planus on the trunk and extremities. Although antitubercular therapy has been linked to cutaneous hypersensitivity reactions, the literature on such cases is scarce. Here, we present a case to contribute to this field, reporting on its presentation and management, and reviewing previous case studies. Case Report: Our patient, a 63-year-old male, presented with black pigmented patches on the skin, having been diagnosed with pulmonary tuberculosis and on antitubercular therapy for the past two months. A diagnosis of ATT-induced lichen planus was made, and all ATT was stopped. The patient was treated with antihistamines, apremilast, tacrolimus, and corticosteroids, and rechallenge of each drug was performed consecutively. No new lesions appeared after rechallenge with isoniazid and rifampicin. However, ethambutol was not reintroduced due to strong suspicion, by exclusion, that it was the offending agent, whereas on rechallenge with isoniazid and rifampicin, the patient’s skin lesions gradually improved with eventual resolution of hyperpigmentation. Discussion and Conclusion: Lichenoid drug eruptions are characterized by type IV hypersensitivity reactions, and rechallenge is required to ensure safer treatment since the risk of disseminated and multi-drug-resistant tuberculosis increases with the cessation of antitubercular therapy.

Publisher

Medknow

Reference11 articles.

1. Lichenoid reaction caused by antihistamines and corticosteroids;Suryana;J Asthma Allergy,2020

2. A case series of generalized lichenoid drug eruption due to anti-tubercular drugs: Treated with immunosuppressant's while continuing anti-tubercular therapy;Pathave;Indian J Drugs Dermatol,2022

3. Case report isoniazid induced generalized lichenoid drug eruption: An unusual offender;Singh;Indian J Phar Pract,2020

4. Rifampicin-induced lichenoid drug eruption;Bhanja;Postgrad Med J,2020

5. A Case of cycloserine-induced lichenoid drug eruption supported by the lymphocyte transformation test;Kim;Allergy Asthma Immunol Res,2017

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