Ranitidine/rifampicin

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DRESS: case report. A 20-year-old man developed drug reaction with eosinophilia and systemic symptoms (DRESS) following treatment with ranitidine and rifampicin. The man developed reactivation of DRESS following patch test (PT) with ranitidine. Initially, he had developed erythema multiforme-like DRESS (RegiSCAR score 6) in July 2016. Nine months later, initial skin testing showed positive patch test (PT) and intradermal test (IDT) for ranitidine. He also underwent skin testing with rifampicin and vancomycin, which were found to be negative. However, in vitro T-cell assays revealed positive response to ranitidine, vancomycin and rifampicin. The unexpected invitro multiple positive results in the setting of negative skin tests to vancomycin and rifampicin raised the possibility of false-positive in-vitro test results. Hence, subsequent challenge with oral rifampicin 300mg was performed, which resulted in DRESS. Based on this, rifampicin was considered as a primary culprit. This finding raised the possibility that the ranitidine skin/in-vitro testing results might be false positive, and prompted further investigation (after 33 months). PT (with and without adhesive tape stripping) was performed with ranitidine, rifampicin and vancomycin. Within 24h, pruritus at the site of the ranitidine was noted, with intense erythema, infiltrated, visible vesicles, which were more pronounced on the side with tape stripping. Additionally, urticated exanthema on the upper back was noted. He remained afebrile initially, but within 24h, he developed lymphadenopathy and facial swelling with mild lymphopenia. No eosinophilia or organ involvement were observed. The man was admitted to the hospital and treated with methylprednisolone, followed by a tapering dose of prednisolone over 18 days. On resolution of the symptoms, he was discharged after 48h. After a month, routine blood tests were normal. Challenge to vancomycin was not performed. Based on these findings, DRESS related to ranitidine and rifampicin was considered. Teo YX, et al. Reactivation of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) with Ranitidine Patch Testing. Contact Dermatitis : 26 Oct 2020. Available 803518535 from: URL: http://doi.org/10.1111/cod.13733

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Reactions 5 Dec 2020 No. 1833

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