Abstract

Lupus vulgaris is a form of cutaneous tuberculosis (TB) that commonly affects the face and neck. It is typically treated with standard anti- TB therapy (ATT). However, adverse drug reactions may alter treatment strategies. We report a case of female with red plaque on the left cheek, diagnosed as lupus vulgaris. Standard ATT was initiated but subsequently discontinued due to signs and symptoms of drug-induced liver injury (DILI). The treatment regimen was modified to levofloxacin, ethambutol, and streptomycin, with the gradual reintroduction of rifampicin. Reintroduction of isoniazid led to intolerance symptoms and therefore discontinued. The patient declined reintroduction of pyrazinamide due to fear of recurrence of the same symptoms. Consequently, modified regimen of levofloxacin, streptomycin, ethambutol, and rifampicin was continued in intensive phase, followed by rifampicin and ethambutol in continuation phase. Marked clinical improvement was observed. This case demonstrates successful individualized management of lupus vulgaris with a modified regimen in the setting of DILI, representing the first reported use of this approach.