FIELD OF THE INVENTION
[001] The present invention relates to the field of medical science, and more particularly, the present invention relates to the rare etiology of drug rash in patients receiving anti-tuberculosis treatment.

BACKGROUND FOR THE INVENTION:
[002] The following discussion of the background to the invention is intended to facilitate an understanding of the present invention. However, it should be appreciated that the discussion is not an acknowledgment or admission that any of the material referred to is published, known, or part of the common general knowledge in any jurisdiction as of the priority date of the application. The details provided herein the background if belongs to any publication is taken only as a reference for describing the problems, in general terminologies or principles or both of science and technology in the associated prior art.
[003] Tuberculosis (TB) is an ancient diseasewith an annual incidence of more thannine million cases worldwide. It is well-established that anti-tuberculosistreatment (ATT) regimens are commonlyassociated with various cutaneousadverse drug reactions (CADRs).However, drug rash can also result fromsome other concurrent diseases.
[004] According to World HealthOrganization data, more than 200,000new cases of leprosy are reportedannually throughout the world. Acutereactions and exacerbations of the immunesystem might be observed during thetreatment period.
[005] In light of the foregoing, there is a need for a rare etiology of drug rash in a patient receiving anti-tuberculosis treatmentthat overcomes problems prevalent in the prior art.
OBJECTS OF THE INVENTION:
[006] Some of the objects of the present disclosure, which at least one embodiment herein satisfies, are as follows.
[007] The principal object of the present invention is to overcome the disadvantages of the prior art by providing a rare etiology of drug rash in patients receiving anti-tuberculosis treatment.
[008] An object of the present invention is to provide rare etiology of drug rash in patients receiving anti-tuberculosis treatment, wherein the case highlights the importance ofthe early diagnosis and adequatemanagement of leprosy.
[009] Another object of the present invention is to provide a rare etiology of drug rash in patients receiving anti-tuberculosis treatment, wherein highlights the importance ofearly diagnosis and adequateleprareactions.
[010] Yet another object of the present invention is to provide a rare etiology of drug rash in patients receiving anti-tuberculosis treatment, whereinthe report considers all the differential diagnoseswhile managing patients with TB skinlesions.
[011] Other objects and advantages of the present disclosure will be more apparent from the following description, which is not intended to limit the scope of the present disclosure.

SUMMARY OF THE INVENTION:
[012] The present invention provides a rare etiology of drug rash in patients receiving anti-tuberculosis treatment.
[013] According to one aspect of our invention, The ATT has been found to causevarious CADRs ranging from mildreactions, such as pruritus,maculopapular exanthema, lichenoideruptions, fixed drug eruptions, andurticaria to severe life-threateningreactions, including acute generalizedexanthematous pustulosis, Stevens-Johnson syndrome, and toxic epidermalnecrolysis.
[014] In another aspect of the invention, these CADRs can mimicany morphological manifestation indermatology (2).
[015] In another aspect of the invention, this patient presented with increasedmaculopapular rashes all over the upperextremity and trunk following theinitiation of ATT. It is common toconsider the observed lesions ascutaneous drug reactions; however,detailed analysis and slit-skin smear ledto the diagnosis of leprosy.
[016] In another aspect of the invention, the patienthad pre-existing leprosy, which isunmasked by the anti-mycobacterialtreatment.
[017] In another aspect of the invention, concurrent TB and leprosy have beenreported in some primitive data. Forinstance, archaeologists havedemonstrated leprosy and TB coinfectionin some ancient Roman archaeologicalsamples (5).
[018] In another aspect of the invention, this is notfrequently encountered in generalpractice.
[019] In another aspect of the invention, leprosy and TB are chronicgranulomatous diseases caused by Gram-positive aerobic acid-fast bacilli withslow multiplication rates. Both of theseconditions have been found to have acomparable endemic geographicaldistribution (1).

BRIEF DESCRIPTION OF DRAWINGS:
[020] Reference will be made to embodiments of the invention, examples of which may be illustrated in accompanying figures. These figures are intended to be illustrative, not limiting. Although the invention is generally described in the context of these embodiments, it should be understood that it is not intended to limit the scope of the invention to these particular embodiments.
[021] Figure 1shows a Diffuse maculopapular rash seenon a patientin accordance with the present invention.
[022] Figure 2 shows a closer view of the forearmin accordance with the present invention.
[023] Figure 3 shows a chest X-ray of the patient showingbilateral infiltrates in accordance with the present invention.
[024] Figure 4shows a skin biopsy showing an atrophicepidermis and collections of foamy macrophagesin the epidermisin accordance with the present invention.

DETAILED DESCRIPTION OF DRAWINGS:
[025] While the present invention is described herein by way of example using embodiments and illustrative drawings, those skilled in the art will recognize that the invention is not limited to the embodiments of drawing or drawings described and are not intended to represent the scale of the various components. Further, some components that may form a part of the invention may not be illustrated in certain figures, for ease of illustration, and such omissions do not limit the embodiments outlined in any way. It should be understood that the drawings and the detailed description thereto are not intended to limit the invention to the particular form disclosed, but on the contrary, the invention is to cover all modifications, equivalents, and alternatives falling within the scope of the present invention as defined by the appended claim.
[026] As used throughout this description, the word "may" is used in a permissive sense (i.e. meaning having the potential to), rather than the mandatory sense, (i.e. meaning must). Further, the words "a" or "an" mean "at least one” and the word “plurality” means “one or more” unless otherwise mentioned. Furthermore, the terminology and phraseology used herein are solely used for descriptive purposes and should not be construed as limiting in scope. Language such as "including," "comprising," "having," "containing," or "involving," and variations thereof, is intended to be broad and encompass the subject matter listed thereafter, equivalents, and additional subject matter not recited, and is not intended to exclude other additives, components, integers, or steps. Likewise, the term "comprising" is considered synonymous with the terms "including" or "containing" for applicable legal purposes. Any discussion of documents, acts, materials, devices, articles, and the like are included in the specification solely for the purpose of providing a context for the present invention. It is not suggested or represented that any or all these matters form part of the prior art base or are common general knowledge in the field relevant to the present invention.
[027] In this disclosure, whenever a composition or an element or a group of elements is preceded with the transitional phrase “comprising”, it is understood that we also contemplate the same composition, element, or group of elements with transitional phrases “consisting of”, “consisting”, “selected from the group of consisting of, “including”, or “is” preceding the recitation of the composition, element or group of elements and vice versa.
[028] The present invention is described hereinafter by various embodiments with reference to the accompanying drawing, wherein reference numerals used in the accompanying drawing correspond to the like elements throughout the description. This invention may, however, be embodied in many different forms and should not be construed as limited to the embodiment set forth herein. Rather, the embodiment is provided so that this disclosure will be thorough and complete and will fully convey the scope of the invention to those skilled in the art. In the following detailed description, numeric values and ranges are provided for various aspects of the implementations described. These values and ranges are to be treated as examples only and are not intended to limit the scope of the claims. In addition, several materials are identified as suitable for various facets of the implementations. These materials are to be treated as exemplary and are not intended to limit the scope of the invention.
[029] The present invention relates to the rare etiology of drug rash in patients receiving anti-tuberculosis treatment.
[030] A 60-year-old male referred to thehospital emergency unit with the chiefcomplaints of fever, loss of appetite,generalized ache, and weakness duringthe previous month that exacerbated onthe last four days. The patient had beendiagnosed as a sputum-positive case ofpulmonary TB, and a local generalpractitioner had prescribed ATT fivedays prior to presentation.At the time of admission, the patienthad high-grade fever (103.5°F) andtachycardia (157 bpm) with normalblood pressure and oxygen saturation onroom air. Moreover, he had diffused maculopapular dermal lesions all overthe upper limbs and trunk. In thedetailed history, the patient reportedthat the mentioned lesions hadexacerbated following starting the ATT(Figures 1 and 2; informed consent isreceived from the patient before takingthe photographs).
[031] Routine blood test showed neutrophilicleukocytosis (total white blood cellcount: 17.07×103/µl), moderate anemia (hemoglobin level: 9.05 g/dl), andthrombocytosis (600×103/µl). Urine,blood, and stool cultures are negativefor any pathogenic organism. In addition,chest X-ray demonstrated bilateralinAiltrating lesions (Figure 3).
[032] Although ATT is continued, along withbroad-spectrum antibiotics,fever did notrelieve. The skin biopsy recommended inthe dermatology consultation showedacute or chronic Alammation (Figure 4).Furthermore, slit-skin smear for acid-fast.
[033] Bacilli are requested by thedermatologist,the result of which ispositive. Therefore, the subject is diagnosed withHansen’s disease, and multidrug therapyfor multibacillary leprosy (MDT-MB) isinitiated. In spite of persistentleukocytosis, the fever of the patientsubsided and he is discharged on an ATTregimen, Gram-positive antimicrobials,MDT-MB without weekly rifampicin, andsymptomatic treatment.The patient has referred to the outpatient department again 7 days post-dischargewith complaints of increased lesions,high-grade fever (102°F), and elevatedweakness. He is admitted, and hisblood sample is sent to a laboratory forroutine hematological investigations. Thelaboratory results showed that thepatient had persistent leukocytosis with a total WBC count of 21×103/µl and ATTis continued.
[034] Dermatology consultation concerningthe increased skin lesions suggested thatthe patient is suspected to have a leprareaction. The high-grade fever continued,and thalidomide, clofaziminem, and broad-spectrum antibiotics areadministered. Afterward, the fever subsidedand serial blood counts indicated adeclining trend in the leukocyte count.The lesions settled, and the patient isdischarged on ATT, along withthalidomide, a nonsteroidal anti-inflammatory drug (NSAID), andsymptomatic treatment. Finally, thesymptoms of the patient improved. He iscurrently on follow-up receiving ATT andMDT-MB with thalidomide.
[035] The ATT has been found to causevarious CADRs ranging from mildreactions, such as pruritus,maculopapular exanthema, lichenoideruptions, fixed drug eruptions, andurticaria to severe life-threateningreactions, including acute generalizedexanthematous pustulosis, Stevens-Johnson syndrome, and toxic epidermalnecrolysis (4). These CADRs can mimicany morphological manifestation indermatology (2).
[036] This patient presented with increasedmaculopapular rashes all over the upperextremity and trunk following theinitiation of ATT. It is common toconsider the observed lesions ascutaneous drug reactions; however,detailed analysis and slit-skin smear ledto the diagnosis of leprosy. The patienthad pre-existing leprosy, which isunmasked by the anti-mycobacterialtreatment.Concurrent TB and leprosy have beenreported in some primitive data. Forinstance, archaeologists havedemonstrated leprosy and TB coinfectionin some ancient Roman archaeologicalsamples (5). However, this is notfrequently encountered in generalpractice. Leprosy and TB are chronicgranulomatous diseases caused by Gram-positive aerobic acid-fast bacilli witslow multiplication rates. Both of theseconditions have been found to have acomparable endemic geographicaldistribution (1).
[037] The annual incidence of leprosy isreported to be more than 200,000 cases(3). Few post-mortem studies reportedTB as the cause of death in patients withleprosy, especially in the anergic formsthat predispose the patients to TB (6).Dominance of TB is revealed in thepatients with borderline andlepromatous disease.Many cases have been reported in theliterature with the coinfection of TB andleprosy. A case similar to the presentpatient is reported by Shetty et al. (7)and they initiated MDT along with ATTregimen. In addition, these authorsprescribed low-dose prednisoloneaccompanied by lepra reactions therapy.The mentioned authors reported thiscoinfection as not very frequent. Ourpatient developed a type 1 lepra reactionfollowing the administration of MDT.There is no ocular or neuralinvolvement in the current case, and thepatient responded to thalidomide,clofazimine, and NSAIDs. It should bementioned that the reaction is mild,and steroids are not required in ourcase.
[038] This case highlights the importance ofthe early diagnosis and adequatemanagement of leprosy, as well as leprareactions. Moreover, it is of great value toconsider all the differential diagnoseswhile managing the patients with TB skinlesions.
[039] The disclosure has been described with reference to the accompanying embodiments herein and the various features and advantageous details thereof are explained with reference to the non-limiting embodiments in the following description. Descriptions of well-known components and processing techniques are omitted so as to not unnecessarily obscure the embodiments herein.
[040] The foregoing description of the specific embodiments so fully revealed the general nature of the embodiments herein that others can, by applying current knowledge, readily modify and/or adapt for various applications such specific embodiments without departing from the generic concept, and, therefore, such adaptations and modifications should and are intended to be comprehended within the meaning and range of equivalents of the disclosed embodiments. It is to be understood that the phraseology or terminology employed herein is for the purpose of description and not of limitation. Therefore, while the embodiments herein have been described in terms of preferred embodiments, those skilled in the art will recognize that the embodiments herein can be practiced with modification within the scope of the embodiments as described herein.

We Claim:

1) A rare etiology of drug rash in patients receiving anti-tuberculosis treatment, wherein ATT has been found to cause various CADRs ranging from mild reactions, such as pruritus, maculopapular exanthema, lichenoid eruptions, fixed drug eruptions, and urticaria to severe life-threatening reactions, including acute generalized exanthematous pustulosis, Stevens-Johnson syndrome, and toxic epidermal necrolysis.

2) The case study as claimed in claim 1, wherein the CADRs can mimic any morphological manifestation in dermatology.

3) The case study as claimed in claim 1, wherein the patient presented with increased maculopapular rashes all over the upper extremity and trunk following the initiation of ATT. The case study as claimed in claim 1, whereinit is common to consider the observed lesions as cutaneous drug reactions; however, detailed analysis and slit-skin smear led to the diagnosis of leprosy.

4) The case study as claimed in claim 1, wherein the patient had pre-existing leprosy, which is unmasked by the anti-mycobacterial treatment.
5) The case study as claimed in claim 1, wherein the concurrent TB and leprosy have been reported in some primitive data.
6) The case study as claimed in claim 1, wherein, for instance, archaeologists have demonstrated leprosy and TB coinfection in some ancient Roman archaeological samples.

7) The case study as claimed in claim 1, wherein leprosy and TB are chronic granulomatous diseases caused by Gram-positive aerobic acid-fast bacilli with slow multiplication rates.

8) The case study as claimed in claim 1, whereinboth of the conditions have been found to have a comparable endemic geographical distribution.