Giant Tuberculin Reaction Associated With the Homeopathic Drug Tuberculinum: A Case Report

Δημιουργηθηκε στις Δευτέρα, 20 Ιουλίου 2015 11:11

The tuberculin skin test (TST) is the most widely used screening tool for the detection of latent tuberculosis. Skin reaction to intradermal injection of tuberculin, a purified protein derivative (PPD) of tubercle bacilli, is based on the induction of a delayed- type hypersensitivity response in subjects presensitized to mycobacterial antigens [1]. According to the latest guidelines and recommendations by the American Thoracic Society and the Centers for Disease Control and Prevention, a cutoff point of 15 mmshould be used for separating positive from negative skin reactions to tuberculin in low-risk groups (patients from lowincidence regions, with no history of tuberculosis contact, immunosuppression, or other known risk factor for tuberculosis) [1].

Giant reactions to tuberculin, defined as accelerated and exaggerated responses typically exceeding 40 mm in diameter, are extremely rare and have been previously reported almost exclusively in individuals with lepromatous leprosy [2, 3] and only occasionally in patients with active tuberculosis [2, 4]. To the best of our knowledge, large tuberculin reactions in the absence of active mycobacterial infection have been previously reported only as a result of inadvertent injection of vaccine instead of a PPD product [5].We report a tuberculin reaction of 100 mm in diameter, associated with administration of Tuberculinum, a homeopathic drug prepared from tuberculous tissue, in a patient with no evidence of active mycobacterial infection. A propos of this case, the need for improved safety and quality control of homeopathic medicines prepared from potentially hazardous biological materials is also briefly discussed.

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