ABSTRACT
Pediatric drug reaction with eosinophilia and systemic symptoms (DRESS) is a life-threatening uncommon disease that can be difficult to diagnose. We present a case of a 10-year old girl with ten days of high fever during her fifth week of ATT (consisting of isoniazid, rifampicin, and pyrazinamide), followed by appearance of pruritic morbiliform rash and severe liver injury. The fever decreased after discontinuation of the ATT and oral steroid administration, followed by resolution of other symptoms. The diagnosis of TB disease in this patient was made in primary health care using pediatric TB scoring system. Despite the total score of 6 (positive tuberculin test and TB exposure), she has normal chest X-ray and no symptoms of TB. Therefore, the patient has latent tuberculosis infection (LTBI) but overdiagnosed as TB disease. Due to the negative HIV status of the patient, TB prophylaxis is not indicated. Therefore, reintroduction of ATT was contraindicated, which led to lack identification of specific drug causing DRESS in this case.
