İlaç Alerjisi Gelişen Ürogenital Tüberküloz Vakası: Olgu Sunumu

Tüberküloz basilinin inhalasyonu, immün yanıtın uyarılmasıyla etkenin temizlenmesi ya da primer enfeksiyon oluşumu ile sonuçlanır. Primer tüberküloz enfeksiyonu, olguların %95’inde sessiz seyreder ve latent döneme girer. Olguların %5'inde ise primer tüberküloz hastalığına neden olur. Bu evrede mikobakteriler hematojen, lenfojen yol ile çevre dokulara ve akciğer dışı organlara yerleşebilir. Akciğer dışındaki odaklarda reaktivasyon olursa ekstrapulmoner tüberküloz ortaya çıkmaktadır. Ürogenital tüberküloz (ÜG-TB); plevral tüberküloz ve periferal lenfadenopatiden sonra en sık karşılaşılan ekstrapulmoner tüberküloz şeklidir. Böbrekler genellikle basilin akciğerden hematojen yol ile yayılması sonucu enfekte olmaktadır. Akciğer röntgenogramında, ÜG-TB vakalarının yaklaşık yarısında spesifik bulgu izlenmemektedir. Tedavi edilmemiş olgular renal parankim hasarı ve obstrüktif nefropati ile birlikte son dönem böbrek yetmezliğine sebep olabilir. Bu olgumuzda ürogenital tüberküloz tanısı almış hastada bir ilaç yan etkisi olarak gelişen hipersensitivite reaksiyonu ve bunun yönetiminden bahsedilmiştir.

Anahtar Kelimeler:

Ürogenital tüberküloz, ekstrapulmoner tüberküloz, ilaç yan etkisi

Case Report: Management of Adverse Drug Reaction in Patient with Urogenital Tuberculosis

Inhalation of tuberculosis bacillus triggers immune response and as a result it causes elimination of the causetive agent or it may end up with the manifestation of primary infection. In most of the cases, %95 of primary tuberculosis infection results in containment and enters the latent period whereas around %5 of the cases result progressive primary tuberculosis, at this stage mycobacterium may spread to adjacent and extrapulmonary tissues via hematogenous and lymphatic spread. If reactivation occurs in foci out of lungs, then extrapulmonary tuberculosis arises. Urogenital tuberculosis (UG-TB) is the third most common site of extrapulmonary tuberculosis following pleural tuberculosis and peripheral lympadenopathy. Kidneys are usually infected via hemotogenous spread of the bacillus from the lungs. Chest radiograph reveals no specific findings in almost half of the UG-TB cases. Untreated disease may result renal parenchyma damage and obstructive nephropathy and as a result end-stage renal disease occurs. In this case it is mentioned about hypersensitivity drug reaction that occured in patient with the diagnosis of urogenital tuberculosis.

Keywords:

Urogenital tuberculosis, extrapulmonary tuberculosis, adverse drug reaction,

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1. World Health Organization. "Global tuberculosis report 2018. 2018."Geneva: World Health Organization (2019).
2. Muneer, Asif, et al. "Urogenital tuberculosis—epidemiology, pathogenesis and clinical features."Nature Reviews Urology 16.10 (2019): 573-598.
3. Yaman, Mustafa. "TÜBERKÜLOZ PATOGENEZ‹."İÜ Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Etkinlikleri Erişkin ve Çocukta Tüberküloz Sempozyumu (1999): 15-20.
4. Fanning A. Tuberculosis: 6. Extrapulmonary disease. CMAJ. 1999;160(11):1597-1603
5. Furin, J., Cox, H. & Pai, M. Tuberculosis. Lancet 393, 1642–1656 (2019).
6. Kara F. Tüberküloz Tanı ve Tedavi Rehberi. Ankara, Sağlık Bakanlığı, 2019.
7. Sandgren, A., V. Hollo, and M. J. Van Der Werf. "Extrapulmonary tuberculosis in the European Union and European economic area, 2002 to 2011."Eurosurveillance 18.12 (2013): 20431.
8. Toccaceli, S., et al. "Renal tuberculosis: a case report."Il Giornale di Chirurgia 36.2 (2015): 76.
9. Büyükalpelli, Recep, and S. Yıldız. "Genitoüriner sistem tüberkülozu."OMÜ Tıp Derg 1996; 13: 327 32 (1996).
10. Amaya-Tapia, Gerardo, and Guadalupe AguirreAvalos."UrinaryTractTuberculosis."Tuberculosis. IntechOpen, 2018.
11. Kollins, Stephen A., et al. "Roentgenographic findings in urinary tract tuberculosis: a 10 year review."American Journal of Roentgenology 121.3 (1974): 487-499.
12. de Oliveira, Jobson Lopes, Geraldo Bezerra da Silva Junior, and Elizabeth De Francesco Daher. "Tuberculosis-associated chronic kidney disease."The American journal of tropical medicine and hygiene 84.6 (2011): 843-844.
13. Garcia-Rodriguez, J. A., et al. "Genitourinary tuberculosis in Spain: review of 81 cases."Clinical infectious diseases 18.4 (1994): 557-561.
14. Priyadarshini Bai, G. "A study of adverse drug reactions among pulmonary tuberculosis patients treated under dots in a tertiary care hospital."International Journal of Basic & Clinical Pharmacology 6.4 (2017): 779.
15. Tan, W. C., et al. "Two years review of cutaneous adverse drug reaction from first line anti-tuberculous drugs."Medical Journal of Malaysia 62.2 (2007): 143.
16. Kobashi, Yoshihiro, et al. "Desensitization therapy for allergic reactions to antituberculous drugs."Internal Medicine 49.21 (2010): 2297-2301.
17. Ban, Ga-Young, et al. "Efficacy and tolerability of desensitization in the treatment of delayed drug hypersensitivities to anti-tuberculosis medications." Respiratory Medicine 147 (2019): 44-50.