Hypersensitivity reactions may occur during antituberculous chemotherapy. Severe reactions are rare, and in the three years 1983-86 during which we have both worked in Africa managing large numbers of patients with tuberculosis we only saw one or two cases with severe and generalised cutaneous hypersensitivity. In the last 12 months, however, there have been a number of cases with severe Stevens-Johnson syndrome which developed during antituberculous chemotherapy and has invariably been associated with seropositivity to HIV (human immunodeficiency virus).
PIP: Severe cutaneous hypersensitivity historically has been an extremely rare complication of antituberculous chemotherapy in African patients. However, the authors have observed 6 such cases in the past year alone in Malawi. In 5 of these cases, patients with sputum-negative pulmonary tuberculosis who were treated with streptomycin, isoniazid, and thiacetazone developed severe Stevens-Johnson syndrome in association with high fever in the third or fourth week of chemotherapy. The 6th patient with Stevens-Johnson syndrome in association with high fever in the third or fourth week of chemotherapy. The 6th patient with Stevens- Johnson syndrome was diagnosed with tuberculous pleural effusion. All 6 patients had concomitant human immunodeficiency virus (HIV) infection. It is unknown how HIV infection apparently promotes severe cutaneous side effects in antituberculous chemotherapy recipients. Thiacetazone is considered to be the agency responsible for this side effect, and use of the more expensive streptomycin, rifampicin, isoniazid, and pyrazinamide regimen is recommended. Given the association between HIV infection and a hypersensitivity reaction, all patients who developed Stevens-Johnson syndrome should be screened for HIV.