Pyrazinamide is primarily used in the treatment of active tuberculosis as a first line agent. Gastric adverse effects due to Pyrazinamide have been commonly reported. On the contrary, skin rash and photosensitivity as a side effect are seldom observed. We reported a case of maculopapular rash due to Pyrazinamide in a patient on anti-tuberculosis treatment (ATT) for right sacroiliac joint tuberculosis, using three questionnaire systems. The patient developed maculopapular rash on receiving combination ATT. The rash disappeared after discontinuation of the suspected drug. The patient was rechallenged with pyrazinamide, which led to reappearance of rash. The causality and severity were assessed using the Naranjo algorithm, WHO-UMC causality assessment score and Hartwig scale. In developing countries, musculoskeletal tuberculosis has a high prevalence with pyrazinamide as the first line drug. Since rare adverse effects like skin manifestations may lead to non compliance of the patient to the therapy. Hence, awareness, early detection and timely management may hold prime importance.

Keywords: Pyrazinamide, Maculopapular rash, sacro-iliac tuberculosis, Naranjo algorithm, WHO-UMC causality assessment scale, Hartwigs scale.

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