RESUMO
Toxic epidermal necrolysis (TEN) is a severe and potentially fatal adverse drug reaction. This case report presents a 19-year-old male with pulmonary tuberculosis undergoing anti-tubercular therapy who developed TEN. The patient had multiple comorbidities including type 1 diabetes mellitus and multisystem atrophy. ChatGPT was utilized alongside conventional methods to assess causality. While conventional scoring systems estimated mortality at 58.3% (SCORTEN) and 12.3% (ABCD-10), ChatGPT yielded divergent scores. Causality assessment using WHO-Uppsala Monitoring Centre (UMC) and Naranjo's scale indicated rifampicin and isoniazid as probable causative agents. However, ChatGPT provided ambiguous results. The study underscores the potential of AI in pharmacovigilance but emphasizes caution due to discrepancies observed. Collaborative utilization of artificial intelligence (AI) with clinical judgment is advocated to enhance diagnostic accuracy and treatment decisions in adverse drug reactions. This case highlights the importance of integrating AI into drug safety systems while acknowledging its limitations to ensure optimal patient care.
RESUMO
Drug-induced urticaria and angioedema cases are typically reversible upon discontinuation and can be triggered by antibiotics, angiotensin-converting enzyme inhibitors, or nonsteroidal anti-inflammatory drugs. Piperacillin-tazobactam, a common broad-spectrum antimicrobial, has been linked to severe adverse reactions, such as thrombocytopenia, hemolytic anemia, and Steven Johnson syndrome in some cases. A 35-year-old male presented to the emergency department with fever, cough, and acute breathlessness, complicating his ongoing treatment for pulmonary tuberculosis with bedaquiline and delamanid. He was admitted and received supportive care. On the third day of intravenous piperacillin-tazobactam, he developed drug-induced urticaria and angioedema, which resolved upon discontinuing the drug. Piperacillin/tazobactam-induced hypersensitivity reaction is an immunologic and IgE-mediated immediate reaction. IgE-mediated immediate reactions to three major phenotypes of allergic patients with confirmed to piperacillin/tazobactam are either (1) sensitized to the ß-lactam ring or (2) sensitized to the lateral chain of aminopenicillins or (3) selective to piperacillin/tazobactam alone. A skin patch test is advised, or prescribed to avoid hypersensitivity reactions due to piperacillin/tazobactam. This case underscores the challenges of non-adherence to anti-tubercular therapy, leading to drug resistance and prolonged, costly, and sometimes intolerable treatments. Regular patient follow-up, counseling, monitoring, and healthcare provider involvement are essential to enhance treatment adherence. Adverse drug reactions must be promptly reported and managed, and patient-centric approaches are crucial. Digital patient records and standardized data collection are recommended for program evaluation and global policy development. Causality assessment for piperacillin-tazobactam was diagnosed as the probable cause of drug-induced urticaria and angioedema. This case highlights the importance of adherence to tuberculosis treatment to prevent drug resistance. Overall, patient-centered care, monitoring adverse events of drug added, and better data collection are crucial for successful tuberculosis management.
