Management of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome in a female Indonesian with pulmonary tuberculosis: A rare case report

Background Anti-tuberculosis drugs (ATD) induced DRESS syndrome is rarely reported, and its diagnosis and management are very challenging. Case presentation A 33-year-old woman presented with fever, maculopapular rashes, hypereosinophilia, and hepatic involvement, which occurred 4 weeks after a fixed-dose combination of first-line ATD containing rifampicin, isoniazid, pyrazinamide, and ethambutol. The patient's condition improved after the withdrawal of the drugs and administration of systemic steroids. Furthermore, active pulmonary tuberculosis was treated with second-line ATD containing streptomycin, levofloxacin, and ethambutol with no adverse reaction. Discussion Early identification of the causal drug for ATD-induced DRESS syndrome is essential, and it helps to facilitate the treatment process. In some cases, the change from first-line ATD to second-line in pulmonary tuberculosis patients with the syndrome can be considered after recovery with strict follow-up. Furthermore, the administration of systemic corticosteroids for tuberculosis treatment is still debatable, but it had positive effects in this study. Conclusion Early recognition and withdrawal of all suspected drugs are crucial in managing DRESS because the delayed diagnosis can be life-threatening. The administration of systemic steroids is effective against DRESS in pulmonary tuberculosis infection

ANALISIS PERMINTAAN TRANSJAKARTA

ANALISIS PERMINTAAN TRANSJAKARTA

The Increasing Level of DKK-1 as a New Bone Formation Factor in Patients with Early Spondyloarthritis

The role of dickkopf-related protein 1 (DKK-1) in radiographic development may become a robust marker for early spondyloarthritis (SpA) diagnosis. This study aimed at determining the serum DKK-1 profile in patients with SpA and investigating its relationship with SpA progression. Supported by analyzing the BMD data which aims to affirm the potential of DKK-1 as a biomarker for early diagnosis of SpA, this research may become the early study to produce a robust tool to diminish the fatal impacts in SpA. This cross-sectional study included patients with SpA using ASAS 2010 criteria from Dr. Soetomo General Hospital, Indonesia. Collected data included patients’ general characteristics, disease duration, disease activity using ASDAS-CRP and ASDAS-ESR, serum DKK-1 levels, and BMD. The patients were classified as early SpA if the disease duration was ≤5 years and established SpA if the disease duration was >5 years, while the low BMD was indicated by Z score ≤ −2.00. The correlation was tested using the Spearman or Pearson test. The differences in patients’ characteristics among early and established SpA and also between low and normal BMD were tested using the unpaired T-test or the Mann–Whitney test. The serum DKK-1 levels in early SpA (7365 ± 2067 pg/dL) were significantly higher than those in established SpA (5360 ± 1054 pg/dL). Serum DKK-1 levels were also associated with disease duration (r = −0.370, p=0.040) and BMD at the total hip (r = 0.467, p=0.028). The differences in all patients’ clinical parameters were not found between patients with low BMD at any site and patients with normal BMD unless in the BMI (p=0.019). Our findings found DKK-1 as a potential diagnostic marker for early SpA. Early diagnosis may lead to rapid treatment to delay disease progression and prevent future impairment