Pyrazinamide-Induced Exfoliative Dermatitis in a Patient on Hemodialysis: A Rare Complication

A 60-year-old male patient on maintenance hemodialysis was started on antituberculosis therapy with isoniazid, rifampin, ethambutol, and pyrazinamide for pulmonary tuberculosis. After 4 weeks of therapy, he developed pruritic lesions in the extremities followed by exfoliation. The lesions progressively spread over the entire body. Lesions resolved after withdrawal of antituberculosis medications and administration of oral corticosteroids and antihistamines. After 2 weeks antituberculosis drugs were rechallenged one at a time. Administration of oral pyrazinamide resulted in reappearance of symptoms (pruritis and erythema) within 48 hours. Pyrazinamide was substituted with ofloxacin while other three drugs were restarted without any side effects. The case illustrates a rare but potentially dangerous complication of pyrazinamide therapy.