Abstract
Case report: We present a forty five year old male of chronic hepatitis in active phase and was started on antiviral treatment with Tenofovir 300 mg daily once. Patient when first time took the tablet then within fifteen minutes, felt some uneasiness and mild itching which progressed to severe allergic reaction all over body within two hours. He was symptomatically treated with anti-allergic by local private practitioner and within two three hours settled. After few days, he again tried tablet tenofovir and same kind of episode of allergic reaction occurred and was treated in same way. Next day, he reported to our department. We had treated more than 1500 patients with tenofovir in last few years but never has seen such type of allergic reaction. For exact confirmation of symptoms, we in our own presence in hospital with all emergency drugs by corner, gave a tablet of tenofovir 300 mg of different and fresh batch. He within fifteen minutes complained about abnormal vague sensation near oral cavity. Hence for reconfirmation, he was sent for dermatological consultation in the same institute. But due to overcrowding of patients in dermatology department, there was delay in consultation of this patient of around one hour. In this duration, patient developed severe anaphylactic reaction, as evidenced by severe itching and rash all over the body, hypotension, vomiting, dizziness and tacypnoea. The itching was so intense, that he was just trying to peel of his skin with nails. He was immediately admitted to our indoor ward and treated with anti-allergic, intravenous steroid and other supportive therapy. He responded to treatment within two hours and became totally asymptomatic. He was labeled as allergic to tenofovir in his medical records and was discharged after one day observation. He was called on follow up for starting on another group of antiviral treatment but due to fear of allergic reaction has not reported till date.
Conclusion: Tenofovir associated severe allergic reaction and anaphylaxis are rare but do occur, hence merit a careful vigil for the same. If overlooked then can lead to life threatening condition. We also for confirming the same, did a drug challenge test but in hospital surrounding with all emergency measures backup.