Volume 190 - Issue 7
Isoniazid hypersensitivity in a child
Authors: Tony D Merritt and Peter D Massey
Med J Aust 2009; 190 (7): 397. || doi: 10.5694/j.1326-5377.2009.tb02464.x
Published online: 6 April 2009
Published online: 6 April 2009
To the Editor: Isoniazid is used extensively for the treatment of active and latent tuberculosis (TB). It is generally well tolerated by children, and hypersensitivity reactions resulting in skin rash and requiring cessation of treatment are rarely reported in this age group.1,2
We report a case of isoniazid hypersensitivity in a 21-month-old boy potentially exposed to TB in a childcare setting. He was one of over 80 children screened after contact with a childcare worker who showed a positive smear result. His initial tuberculin skin test (TST) was negative and, in line with New South Wales guidelines,3 he was commenced on isoniazid 150 mg daily (10mg/kg/day) while awaiting a repeat TST.
After 3 days of treatment, he developed a small number of round vesicular lesions on his tongue. They were associated with mild discomfort but his appetite was not affected. There were three small maculopapular lesions on his legs and back that reportedly looked like mosquito bites before blistering. The child remained afebrile and was systemically well.
The family general practitioner considered that this presentation was possibly an allergic reaction and isoniazid was discontinued. Population health staff were consulted, and the risks and benefits of further isoniazid treatment were discussed with paediatric TB specialists. It was recommended that, after the rash had resolved, isoniazid be reintroduced at half the dosage and with close supervision.
Two days after isoniazid 75 mg daily was recommenced, the rash recurred. The child’s mother described lesions appearing as “burns all over his tongue” and reported further sores around his lips and six welt-like lesions on his legs. Isoniazid was immediately discontinued, the skin lesions resolved within 5 days and no further antituberculous therapy was administered. His repeat TST 12 weeks after the initial test was negative and he remains well.
No other potential triggers for a hypersensitivity reaction were identified. In particular, no other medications were administered during this period or for the week before commencing isoniazid.
According to his mother, the child had experienced a similar reaction within 1 hour of a single dose of ibuprofen when he was 8 months old. Several tongue blisters were accompanied by a generalised fine maculopapular rash lasting several days.
We concluded that the child most likely had a hypersensitivity reaction to isoniazid that required discontinuation of treatment. We reported this to the Therapeutic Goods Administration, which advised that it had received seven other reports since 1991 of suspected hypersensitivity, but none were for children under 10 years of age.
References
- Altet Gómez MN, Alcáide Megías J, Boque Genovard MA. [Toxicity in the current treatment of tuberculosis in children] [Spanish]. An Esp Pediatr 1984; 20: 18-27. 0_CBBBBBGG
- Padmini R, Srinivasin S, Nalini P, Mahadevan S. Short course chemotherapy for pulmonary tuberculosis in children. J Trop Pediatr 1993; 39: 361-364. 0_CBBDEAGE
- NSW Health. Tuberculosis contact tracing. Policy directive PD2008_017. 7 Apr 2008. http://www.health.nsw.gov.au/policies/pd/2008/pdf/PD2008_017.pdf (accessed Mar 2009).
Barriers and Facilitators to Timely Detection and Optimal Management of Chronic Wet Cough in Aboriginal Children Across Australia From the Perspectives of Carers of Aboriginal Children: A Qualitative Study
Gloria T. Y. Lau, Pam Laird, Robyn Aitken, Melanie Barwick, Liam Bedford, Emily R. Bowden, Jamie Everingham, Angela Fuery, Reece Griffin, Neha Jain, Mina Kinghorn, Renae Knapp, Gabrielle B. McCallum, Peter Morris, Richard Norman, Peter C. Richmond, Aarti Saiganesh, Slade Sibosado, Cameron Taylor, Maree Toombs, Roz Walker, Joan Wilson, Anne B. Chang, André Schultz
Barriers and Facilitators to Timely Detection and Optimal Management of Chronic Wet Cough in Aboriginal Children Across Australia From the Perspective of Health Care Providers: A Qualitative Study
Gloria T. Y. Lau, Pamela Laird, Robyn Aitken, Melanie Barwick, Liam Bedford, Emily R. Bowden, Corey Dalton, Jamie Everingham, Angela Fuery, Reece Griffin, Neha Jain, Mina Kinghorn, Renae Knapp, Gabrielle B. McCallum, Peter Morris, Richard Norman, Peter C. Richmond, Aarti Saiganesh, Slade Sibosado, Maree Toombs, Roz Walker, Joan Wilson, Anne B. Chang, André Schultz
Short-Term Safety of Concomitant Meningococcal B and National Immunisation Program Vaccines in Infants Aged < 15 Months: A Survey-Based Surveillance Study
Thuy Nguyen, Evelyn C. S. Tay, Michael Dymock, Thomas L. Snelling, Lucy Dawes, Julie Marsh, Yue Wu, Alan Leeb, Nicholas Wood, Lucy Deng
The GenV Biobank: Enabling Biological Research in a Large Longitudinal Population-Representative Cohort of Australian Newborns and Their Parents
Katherine Lange, Kim L. Powell, Yeukai Mangwiro, Tony Frugier, Donna T. Geddes, Melissa Wake, Richard Saffery
Watchful Waiting Compared With Immediate Antibiotics for Urban Aboriginal and Torres Strait Islander Children With Uncomplicated Acute Otitis Media (WATCH): A Non-Inferiority Randomised Controlled Trial
Jennifer S. Reath, Hasantha Gunasekera, Sanja Lujic, Amanda J. Leach, Letitia Campbell, Robyn Walsh, Tim Usherwood, Geoffrey K. Spurling, Claudette A. Tyson, Deborah A. Askew, Kelvin Kong, Chelsea J. Watego, Peter Morris, Wendy Hu, Penelope A. Abbott
A Rare Case of Storage Mite Anaphylaxis in Infancy
Eliza Kluckow, Katie Frith