{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:51:17Z","timestamp":1782489077241,"version":"3.54.5"},"reference-count":9,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,3,12]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:p>Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but potentially fatal hypersensitivity reaction characterised by rash, fever, eosinophilia and multiorgan involvement. Although antiepileptics are common triggers, antitubercular therapy (ATT) is increasingly recognised as a cause in tuberculosis-endemic regions. Pulmonary involvement is uncommon and can mimic disease progression or superadded infection, creating diagnostic confusion. We report a diabetic woman in her late 40s with pulmonary tuberculosis who developed a diffuse erythematous rash, fever, eosinophilia, hepatic and renal dysfunction following ATT initiation. Histopathology and Registry of Severe Cutaneous Adverse Reactions scoring supported DRESS syndrome. Sequential drug rechallenges identified pyrazinamide as the culprit. She subsequently developed new pulmonary infiltrates, which resolved after drug withdrawal and systemic corticosteroids. Extensive infectious workup was negative. This case highlights the need to consider DRESS in patients on ATT presenting with rash and systemic involvement. Early recognition, prompt withdrawal of the offending drug and judicious steroid therapy are crucial to improve outcomes.<\/jats:p>","DOI":"10.1136\/bcr-2026-272380","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T16:05:24Z","timestamp":1775145924000},"page":"e272380","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Pulmonary infiltrates as part of drug reaction with eosinophilia and systemic symptoms syndrome in a patient with pulmonary tuberculosis: a clinical conundrum"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0283-6034","authenticated-orcid":false,"given":"Krishnapriya S","family":"Kumar","sequence":"first","affiliation":[{"name":"Pulmonary,Critical care and Sleep Medicine, All India Institute of Medical Sciences Rishikesh, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruchi","family":"Dua","sequence":"additional","affiliation":[{"name":"Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences Rishikesh, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neirita","family":"Hazarika","sequence":"additional","affiliation":[{"name":"Dermatology, All India Institute of Medical Sciences Rishikesh, Rishikesh, Uttarakhand, India"},{"name":"Dermatology, All India Institute of Medical Sciences Rishikesh, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"2026062608152122000_19.4.e272380.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2011.01.017"},{"key":"2026062608152122000_19.4.e272380.2","doi-asserted-by":"crossref","DOI":"10.3390\/ijms18061243","article-title":"Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): An Interplay among Drugs, Viruses, and Immune System","volume":"18","author":"Cho","year":"2017","journal-title":"Int J Mol Sci"},{"key":"2026062608152122000_19.4.e272380.3","doi-asserted-by":"crossref","first-page":"177","DOI":"10.4103\/idoj.IDOJ_133_19","article-title":"Spectrum of Cutaneous Adverse Drug Reactions to Anti-tubercular Drugs and Safe Therapy after Re-challenge - A Retrospective Study","volume":"11","author":"Sharma","year":"2020","journal-title":"Indian Dermatol Online J"},{"key":"2026062608152122000_19.4.e272380.4","first-page":"3","article-title":"Drug-induced hypersensitivity syndrome (DiHS)\/DRESS: an update in 2019","volume":"74","author":"Shiohara","year":"2019","journal-title":"Allergy"},{"key":"2026062608152122000_19.4.e272380.5","first-page":"786","article-title":"Drug reaction with eosinophilia and systemic symptoms (DRESS): an international consensus update and review of current evidence","volume":"84","author":"Kardaun","year":"2021","journal-title":"J Am Acad Dermatol"},{"key":"2026062608152122000_19.4.e272380.6","doi-asserted-by":"crossref","first-page":"11","DOI":"10.12775\/JEHS.2023.29.01.001","article-title":"When Common Medications Trigger a Rare Reaction: A Review of Clinical Features, Diagnosis, and Treatment Options of DRESS Syndrome","volume":"29","author":"Hajduk","year":"2023","journal-title":"J Educ Health Sport"},{"key":"2026062608152122000_19.4.e272380.7","doi-asserted-by":"crossref","first-page":"3280","DOI":"10.4103\/jfmpc.jfmpc_1031_21","article-title":"DRESS syndrome due to first-line antitubercular therapy - A diagnostic imbroglio!","volume":"11","author":"Patra","year":"2022","journal-title":"J Family Med Prim Care"},{"key":"2026062608152122000_19.4.e272380.8","doi-asserted-by":"crossref","first-page":"3442","DOI":"10.1016\/j.jaip.2021.03.054","article-title":"Reintroduction of Antituberculous Drugs in Patients with Antituberculous Drug-Related Drug Reaction with Eosinophilia and Systemic Symptoms","volume":"9","author":"Oh","year":"2021","journal-title":"J Allergy Clin Immunol Pract"},{"key":"2026062608152122000_19.4.e272380.9","doi-asserted-by":"crossref","first-page":"2180","DOI":"10.1097\/MS9.0000000000000683","article-title":"Drug reaction with eosinophilia and systemic symptoms syndrome secondary to isoniazid and ethambutol: a case report and literature review","volume":"85","author":"Adhikari","year":"2023","journal-title":"Ann Med Surg (Lond)"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-272380","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:21:14Z","timestamp":1782487274000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-272380"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":9,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,2]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/bcr-2026-272380"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-272380","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}