RESUMO
BACKGROUND: Little is known about drug hypersensitivity reactions from antituberculosis drugs. OBJECTIVE: To determine the frequency, risk factors, and characteristics of immediate-type hypersensitivity reactions from first-line antituberculosis drugs and to evaluate the usefulness of a readministration protocol for culprit drugs in this group of patients. METHODS: The study population consisted of patients with tuberculosis who were hospitalized and treated in the authors' hospital in 2011. Demographics and disease and treatment characteristics of patients with immediate-type hypersensitivity from antituberculosis drugs were compared with the other patients. Culprit drugs were readministered gradually according to a defined protocol to patients with immediate-type hypersensitivity. RESULTS: Tree hundred seventy-nine patients were included in the study. Eighteen immediate-type hypersensitivity reactions were detected in 13 patients (3.43%). The only identified risk factor was female sex (odds ratio 4.085). Isoniazid, rifampicin, pyrazinamide, and ethambutol were readministered in 11 patients and rifampicin was readministered in 2 patients, with 6- to 8-step protocols for each drug. Only in 2 patients did allergic reactions with rifampicin develop during the procedure. In these patients, after treatment and complete remission of allergic symptoms, the last tolerated dose was administered and the protocol was completed with the same adjustments. CONCLUSION: Immediate-type allergic reactions from antituberculosis drugs are not rare and not related to disease or treatment characteristics. The protocols used in this study provide a useful and safe method for readministration of culprit drugs to patients with antituberculosis drug hypersensitivity.
Assuntos
Antituberculosos/efeitos adversos , Dessensibilização Imunológica , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade Imediata/etiologia , Corticosteroides/uso terapêutico , Antituberculosos/administração & dosagem , Antituberculosos/uso terapêutico , Estudos de Casos e Controles , Esquema de Medicação , Hipersensibilidade a Drogas/tratamento farmacológico , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade a Drogas/prevenção & controle , Feminino , Rubor/induzido quimicamente , Rubor/epidemiologia , Rubor/prevenção & controle , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Hipersensibilidade Imediata/tratamento farmacológico , Hipersensibilidade Imediata/epidemiologia , Hipersensibilidade Imediata/prevenção & controle , Masculino , Prevalência , Prurido/induzido quimicamente , Prurido/epidemiologia , Prurido/prevenção & controle , Fatores de Risco , Fatores Sexuais , Tuberculose/complicações , Tuberculose/tratamento farmacológico , Urticária/induzido quimicamente , Urticária/epidemiologia , Urticária/prevenção & controleRESUMO
The most common site for gastrointestinal involvement in tuberculosis is the ileocecal region. Tuberculosis of stomach is quite uncommon. It is usually associated with pulmonary tuberculosis or with immunodeficiency. In this case non specific gastrointestinal complaints yielded a diagnosis of primary gastric tuberculosis, which is very rare. Absence of pulmonary focus and endoscopic findings of pangastritis are different features of this case which makes it presentable.
Assuntos
Gastropatias/diagnóstico , Tuberculose Gastrointestinal/diagnóstico , Adulto , Antituberculosos/uso terapêutico , Feminino , Humanos , Gastropatias/tratamento farmacológico , Gastropatias/microbiologia , Tuberculose Gastrointestinal/tratamento farmacológicoRESUMO
We present the case of an extremely rare tumor of the diaphragm. The patient was a middle-aged woman with a 1-month history of dyspnea, fatigue, and cough. Chest roentgenogram and computed tomography scan of the thorax revealed a mass located at the dome of the right diaphragm. Pathologic examination of the biopsy specimen revealed pleomorphic rhabdomyosarcoma.
Assuntos
Diafragma , Neoplasias Musculares/diagnóstico , Rabdomiossarcoma/diagnóstico , Actinas/análise , Biomarcadores Tumorais/análise , Biópsia , Tosse/etiologia , Desmina/análise , Diagnóstico Diferencial , Diafragma/patologia , Diafragma/cirurgia , Dispneia/etiologia , Fadiga/etiologia , Feminino , Humanos , Pulmão/patologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Pessoa de Meia-Idade , Neoplasias Musculares/patologia , Neoplasias Musculares/cirurgia , Pneumonectomia , Rabdomiossarcoma/patologia , Rabdomiossarcoma/secundário , Rabdomiossarcoma/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Pulmonary involvement is one of the most common extra-articular manifestations of rheumatoid arthritis (RA). We studied four smear-positivepulmonary tuberculosis patients who had had RA for 2.5-12 years. Three of them were using corticosteroids at the time of diagnosis. The clinical, radiological and bacteriological features of all the patients were examined. We conclude that when patients with RA have symptoms related to pulmonary involvement, tuberculosis should be considered, particularly in developing countries.