A case report: drug-resistant tuberculosis with drug eruption skin due to second line anti tuberculosis drug and haemoptysis

Abstract

Abstrak. Tuberkulosis resistan obat (TB-RO) adalah kasus tuberkulosis yang resistan terhadap rifampisin dengan atau tanpa resistansi terhadap obat antituberkulosis (OAT) lain. Penatalaksanaan TB-RO menggunakan kombinasi beberapa OAT dalam jangka waktu panjang dengan efek samping pengobatan yang sering menjadi masalah serius sehingga menyebabkan kegagalan pengobatan. Tulisan ini melaporkan kasus laki,laki, 60 tahun, dengan riwayat TB putus obat, datang dengan keluhan batuk darah serta ruam merah gatal di badan dan ektremitas setelah minum obat TB RO regimen jangka pendek. Pemeriksaan sputum Xpert MTB/Rif dengan hasil MTB detected medium rifampicin resistance detected. Dari hasil rontgen toraks didapatkan lesi luas, berupa infiltrat, multipel kavitas dan ukuran kavitas 5,7 cm. Pasien didiagnosis dengan TB Paru Resisten Obat dengan indeks kasus putus obat dan erupsi kulit yang diduga alergi OAT dengan komplikasi hemoptisis. Penatalaksanaan penyebab utama penyakit dengan mengganti regimen jangka pendek dengan panduan regimen individual. Pemberian Regimen individual menggunakan metode single step daily dose escalation sehingga didapatkan alergi clofazime.  Setelah perbaikan klinis, selanjutnya pasien akan dilakukan pemantauan terkait efek samping OAT selama pengobatan melalui evaluasi rutin setiap bulan. Efek samping sering terjadi selama pengobatan TB RO dan mempengaruhi tingkat keberhasilan pengobatan. Pemilihan regimen terapi yang tepat dan pemantauan gejala klinis selama pengobatan sangat penting untuk mempercepat perbaikan klinis pasien.

Kata kunci : Tuberkulosis resistan obat, efek samping OAT, erupsi kulit, single step daily dose escalation, lesi luas, regimen individual. 

Abstracs. Drug-resistant tuberculosis (DR-TB) is a case of rifampicin-resistant tuberculosis with or without resistance to other antituberculosis drugs (ATD). The management of DR-TB using a combination of several ATD in the long term with treatment side effects that arise often becomes a serious problem that causes treatment failure. A case reports of a man, 60 years old, with a history of drug withdrawal, who came with complaints of coughing up blood and itchy red rash on the body and extremities after taking short-term regimens of TB drugs. Xpert MTB/Rif sputum examination with results MTB detected medium rifampicin resistance detected. The chest x-ray, it was found that there were extensive lesions, in the form of infiltrates, multiple cavities and the size of the cavities was 5.7 cm. The patient was diagnosed with drug-resistant pulmonary TB with an index of withdrawal cases and skin eruptions suspected to be allergic to ATD with complications of hemoptysis. Management of the main cause of disease by replacing short-term regimens with individualized regimen guidelines. Individual regimens were administered using the single step daily dose escalation method to obtain drugs that cause skin eruptions due to clofazime allergy. After clinical improvement, the patient will be monitored for OAT side effects during treatment through regular monthly evaluations. The side effects often occur during TB RO treatment and affect the success rate of treatment. Selection of the right therapeutic regimen and monitoring of clinical symptoms during treatment are very important to accelerate the patient's clinical improvement.

Key words: drug-resistant tuberculosis, side effects of ATD, skin eruption, single step daily dose escalation, extensive lesions, individual regimen