Rapid Onset of Cutaneous Adverse Drug Reaction to 2HPMZ/2HPM: A Case Report
Abstract
Background: The World Health Organization (WHO) has endorsed the 4-month tuberculosis (TB) regimen, 2HPMZ/2HPM (Isoniazid, Rifapentine, Moxifloxacin, Pyrazinamide), as a non-inferior alternative to the standard six-month course, representing a major advancement in global TB control. While large clinical trials established its general safety, real-world data and management of its cutaneous adverse drug reactions (CADRs) remain limited.
Case: A case of a 19-year-old male initiated on the 2HPMZ/2HPM regimen for pulmonary TB. Within 30 minutes of treatment initiation, the patient developed a maculopapular erythematous rash on both arms and legs. Given the mild degree, the treatment was continued, along with administration of Cetirizine and Prednisone, for 7 days.
Discussion: This case demonstrates safe continuation of treatment following the emergence of mild CADR. CADR can manifest as early as 30 minutes following ingestion, as exhibited in this case. Showing the importance of close initial observation for the 2HPMZ/2HPM regimen. 7-days of antihistamine and corticosteroid administration also appeared to be sufficient when done promptly.
Conclusion: This case demonstrates the safety and feasibility of maintaining the full 2HPMZ/2HPM regimen despite mild cutaneous manifestations, thus avoiding treatment interruption, the need for complex re-challenge protocols, and potential treatment failure.
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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