rifampin and Abdominal-Pain

Abdominal pain represents a frequent symptom for referral to emergency departments and/or internal medicine outpatient setting. Similarly, fever, fatigue and weight loss are non-specific manifestations of disease. The present case describes the diagnostic process in a patient with abdominal pain and a palpable abdominal mass. Abdominal ultrasonography confirmed the presence of a mass in the mesogastrium. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans oriented toward calcific lymphadenopathies with increased metabolism in the positron emission tomography-computed tomography (PET-CT) scan. Laboratory examinations were inconclusive, although serology for Brucella and the Quantiferon test were positive. After multidisciplinary discussion, the patient underwent surgical excision of the abdominal mass. Histological examination excluded malignancies and oriented toward brucellosis in a patient with latent tuberculosis. The patient was treated with rifampin 600 mg qd and doxycycline 100 mg bid for 6 weeks with resolution of the symptoms. In addition, rifampin was continued for a total of 6 months in order to treat latent tuberculosis. This case underlines the need for a multidisciplinary approach in the diagnostic approach to abdominal lymphadenopathies.

Topics: Abdominal Pain; Brucellosis; Humans; Latent Tuberculosis; Lymphadenopathy; Lymphoma; Positron Emission Tomography Computed Tomography; Rifampin; Tuberculosis

Acalculous cholecystitis etiologies while numerous, some of them are less-known such as brucellosis. In this report, we elaborate the clinical findings, investigations and management of two female patients presenting acalculous cholecystitis in whom diagnosis of acute brucellosis was retained. Both patients had fever, asthenia and abdominal tenderness. Laboratory results showed evidence of inflammation as well as hepatic cytolysis while cholestasis was noted in one patient. In both cases, ultrasound study and CT confirmed the presence of acalculous cholecystitis. Serology (tube agglutination test) led to the diagnosis of brucellosis. Diagnosis of brucellosis-related acute cholecystitis was established in both cases based on imaging findings as well as serology without resorting to cholecystectomy. Favourable clinical response to specific antibiotic therapy further supported our diagnosis as well as our decision to avoid surgery. Although few cases have been reported, brucellosis must be considered as a cause of acalculous cholecystitis, especially in endemic countries.

Topics: Abdominal Pain; Acalculous Cholecystitis; Acute Disease; Animals; Anti-Bacterial Agents; Brucellosis; C-Reactive Protein; Doxycycline; Female; Food Contamination; Humans; Middle Aged; Milk; Raw Foods; Rifampin; Treatment Outcome; Ultrasonography; Vomiting; Young Adult

Daily rifampin therapy is associated with minimal adverse effects, but administration on an intermittent or interrupted basis has been associated with severe immunoallergic reactions such as hemolytic anemia, acute renal failure, and disseminated intravascular coagulation. We describe a patient with Mycobacterium leprae infection who experienced recurrent episodes of disseminated intravascular coagulation after intermittent exposures to rifampin, and review eight previously reported cases of rifampin-associated disseminated intravascular coagulation. In six (75%) cases, previous exposure to rifampin was reported and seven (87.5%) patients were receiving the medication on an intermittent or interrupted basis. Clinical features of rifampin-associated disseminated intravascular coagulation included fever, hypotension, abdominal pain, and vomiting within hours of ingestion. Average time to reaction was 3-6 doses if rifampin was being administered on a monthly schedule. Three (37.5%) of eight reported cases were fatal. A complete history of previous exposure to rifampin is recommended before intermittent therapy with this medication.

Topics: Abdominal Pain; Aged; Anemia, Hemolytic; Disseminated Intravascular Coagulation; Dose-Response Relationship, Drug; Female; Fever; Humans; Hypotension; Leprosy; Rifampin; Vomiting

Topics: Abdominal Pain; Adolescent; Antitubercular Agents; Cote d'Ivoire; Drug Therapy, Combination; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Humans; Isoniazid; Male; Pancreatitis; Pyrazinamide; Rifampin; Travel-Related Illness; Tuberculosis

Rifampicin has been widely used due to its broad antibacterial spectrum. Acute haemolysis is a rarely encountered complication of rifampicin. A 58-year-old woman was admitted to our department because of high-grade fever with rigors, accompanied by abdominal and lumbar pain and laboratory evidence of acute haemolysis. She had been treated for brucellosis initially with doxycycline and streptomycin. Due to subsequent appearance of myositis, ciprofloxacin and rifampicin were added for treatment of localised brucellosis. After intravenous administration of rifampicin, the patient deteriorated significantly. After exclusion of other causes of haemolysis, autoimmune haemolytic anaemia related to rifampicin was established by strongly positive direct Coombs test. Drug withdrawal in conjunction with intravenous immune globulin and prednisolone resulted in resolution of haemolysis and no relapse in the ensuing 1-year period. Our case highlights the importance of recognising commonly administrative drugs as cause of haemolytic anaemia, that can often be life threatening.

Topics: Abdominal Pain; Anemia, Hemolytic, Autoimmune; Anti-Bacterial Agents; Brucellosis; Chills; Female; Fever; Humans; Immunoglobulins, Intravenous; Middle Aged; Prednisolone; Rifampin; Treatment Outcome

Topics: Abdominal Pain; Africa; Anti-Bacterial Agents; Colon, Transverse; Colonoscopy; Diagnosis, Differential; Ethambutol; Female; Humans; Isoniazid; Middle Aged; Mycobacterium bovis; Pyrazinamide; Rifampin; Thailand; Travel; Treatment Outcome; Tuberculosis, Gastrointestinal

Brucellosis is a common zoonotic disease with worldwide distribution and protean clinical manifestations. Therefore, its prompt and timely diagnosis is still challenging. Among several complications of brucellosis, spontaneous bacterial peritonitis (SBP) in previously healthy participants is rarely recognised, although this condition can be fatal if misdiagnosed and untreated. We present a case of a 69-year-old previously healthy stockbreeder who suffered from back pain along with abdominal pain and distension because of ascites of 6-8 weeks duration. Cultures of ascitic fluid and peripheral blood specimens revealed Brucella spp as the causative agent of ascites and spondylodiscitis, which was then confirmed by MRI findings. After appropriate treatment for 4.5 months (streptomycin 1 g/day for 3 weeks intramuscularly, doxycycline 100 mg twice a day orally and rifampicin 900 mg/day orally), the patient fully recovered. Conclusively, in the appropriate epidemiological and clinical setting, the consideration of brucellosis in the differential diagnosis of SBP could be rational as well as life-saving.

Topics: Abdominal Pain; Aged; Animal Husbandry; Anti-Bacterial Agents; Ascites; Back Pain; Brucella; Brucellosis; Doxycycline; Humans; Male; Peritonitis; Rifampin; Streptomycin; Treatment Outcome

Tuberculosis caused by Mycobacterium tuberculosis presents a major health challenge in endemic countries and spares no organ in the human body. This infection is a mimicker of various disease processes such as metastasis, lymphoproliferative diseases, and other granulomatous conditions such as sarcoidosis and fungal infections. The most challenging and important differential is metastasis, especially in the disseminated form of tuberculosis. We present a histopathologically proven case of isolated hepatosplenic tuberculosis that was provisionally diagnosed as lymphoma due to its unusual, restricted involvement of the liver and spleen.

Topics: Abdominal Pain; Antitubercular Agents; Diagnosis, Differential; Ethambutol; Female; Humans; Isoniazid; Middle Aged; Pyrazinamide; Rifampin; Tomography, X-Ray Computed; Treatment Outcome; Tuberculosis, Hepatic; Tuberculosis, Splenic; Weight Loss

A 53-year-old woman was admitted to our hospital due to abdominal pain, diarrhea, and shunt occlusion caused by dehydration. She had undergone hemodialysis due to diabetic nephropathy over a ten-year period. She was hospitalized again with fever and a persistent high serum CRP level. We started antibiotic administration using cefotiam hexetil hydrochloride because of ascites and peritoneum thickening observed by abdominal computed tomography. Although her symptoms, such as abdominal pain and diarrhea, improved after the administration of antibiotics, the ascites and the peritoneum thickening did not improve. On the fourth hospital day, we attempted ascites aspiration to investigate the etiology of the peritonitis. Cytological examination suggested tuberculous peritonitis because of predominant macrophage cell proliferation, a high level of ADA concentration, and a high level of CA125 of ascites. Although QuantiFERON-tuberculosis (QFT) and the Gaffky scale were negative, we started multidrug therapy (isoniazid + rifampicin + pyrazinamide + ethambutol) on the 20th hospital day. She was finally diagnosed as mycobacterium tuberculous peritonitis based on biopsy of the tissue of the ileum and the results of colonoscopy. Administration of antituberculosis chemotherapy improved abdominal fullness and ascites and the patient was discharged on the 97th hospital day. Moreover Kuno et al. reported that serum soluble interleukin-2 receptor(sIL-2R) and CA-125 levels can be used to monitor the response to anti-tuberculosis treatment. In this case, we use these markers to monitor the response to treatment. We experienced a case of tuberculous peritonitis undergoing hemodialysis. Tuberculosis should be suspected when patients undergoing dialysis have long-term fever of unknown etiology. There are many reports stating that the sensitivity and specificity of QuantiFERON-tuberculosis (QFT) and sputum culture are low in latent tuberculosis infection of dialysis patients. Accordingly it is necessary to diagnose mycobacterium tuberculous peritonitis comprehensively by the clinical symptoms and image analysis.

Topics: Abdominal Pain; Antitubercular Agents; Biomarkers; CA-125 Antigen; Diagnosis, Differential; Diarrhea; Drug Combinations; Ethambutol; Female; Humans; Isoniazid; Middle Aged; Peritonitis, Tuberculous; Pyrazinamide; Receptors, Interleukin-2; Renal Dialysis; Rifampin; Treatment Outcome

Topics: Abdominal Pain; Adult; Anemia, Hemolytic; Antibiotics, Antitubercular; Female; Humans; Radiography, Thoracic; Recurrence; Rifampin; Tuberculosis, Pulmonary

Topics: Abdominal Pain; Adult; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Diagnosis, Differential; Doxycycline; Female; Fever; Humans; Nausea; Rifampin; Vomiting

Topics: Abdominal Pain; Adult; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Female; Follow-Up Studies; Humans; Isoniazid; Laparoscopy; Pregnancy; Pregnancy Outcome; Rifampin; Tuberculosis, Female Genital

p-Chloroaniline is more potent at producing methemoglobin than aniline in animal models. This case highlights the clinical presentation of an inhalation exposure to p-chloroaniline and associated laboratory analysis. An in-vitro study evaluating the metabolism of p-chloroaniline in human hepatocytes was undertaken to evaluate the metabolic fate more closely.. A 20 year-old man was working at a chemical waste plant when he developed dizziness, abdominal pain, and nausea. The exam was remarkable for coma, tachycardia, cyanosis, and pulse oximetry of 75%. Arterial blood gases showed a pH 7.38, pCO(2) 41 mmHg, pO(2) 497 mmHg, bicarbonate 24 mEq/L and methemoglobin 69%. Methylene blue administration led to complete recovery without sequelae. p-Chloroaniline was later identified as the chemical involved. He denied direct contact with the chemical, but was not wearing a dust mask or respirator. GC/MS confirmed p-chloroaniline and metabolites in the patient's urine.. Human hepatocytes were incubated with 100 microM p-chloroaniline for 24 hours, in both rifampicin- and vehicle only-treated cells. The cell culture medium was collected for GC/MS analysis for p-chloroaniline metabolites.. Similar to the patient sample, both p-chloroaniline and p-chloroacetanilide were identified by GC/MS in hepatocytes incubated with p-chloroaniline. Neither p-chloroaniline incubated in empty cell culture nor direct GC/MS injection of p-chloroaniline generated any p-chloroacetanilide via non-enzymatic degradation.. The seemingly innocuous dermal and inhalation exposure to p-chloroaniline dust can lead to life-threatening methemoglobinemia. The diagnosis can be confirmed with GC/MS analysis of the patient's urine, searching for p-chloroaniline and its primary metabolite p-chloroacetanilide.

Topics: Abdominal Pain; Acetanilides; Air Pollutants; Aniline Compounds; Antidotes; Bicarbonates; Cells, Cultured; Clinical Laboratory Techniques; Coma; Cyanosis; Dizziness; Gas Chromatography-Mass Spectrometry; Hepatocytes; Humans; Inhalation Exposure; Male; Methemoglobin; Methemoglobinemia; Methylene Blue; Nausea; Occupational Exposure; Oximetry; Rifampin; Tachycardia; Toxicology; Young Adult

A 64-year-old man was admitted with abdominal pain 6 weeks after treatment with intravenous flucloxacillin for cellulitis of his right leg. Urgent operation was necessary for a mycotic aneurysm of the abdominal aorta due to infection with Pasteurella multocida, a microorganism residing in the oral cavity of domestic animals that very rarely causes infection of native arteries or grafts. The aorta was repaired with a rifampin-coated tube graft. Despite postoperative duodenal perforation, abdominal Candida infections, wound dehiscence, and renal insufficiency, the patient is alive 1 year postoperatively.

Topics: Abdominal Pain; Alcoholism; Aneurysm, Infected; Anti-Bacterial Agents; Aortic Aneurysm, Abdominal; Aortography; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Coated Materials, Biocompatible; Humans; Male; Middle Aged; Pasteurella multocida; Prosthesis Design; Rifampin; Tomography, X-Ray Computed; Treatment Outcome

Clofazimine enterophathy is a serious complication of clofazimine when used at high doses for treatment of type 2 lepra or or erythema nodosum leprosum. Objective. A woman is presented who had a delayed diagnosis of leprosy, persistent type 2 lepra reaction and lethal clofazimine enteropathy.. A 31-year-old woman presented leprosy symptoms over a 16-year period without medical diagnosis of her disease. During this period, type 2 lepra episodes occurred, but were not accurately diagnosed. These episodes became more severe during her second pregnancy. The patient and her family were interviewed, and her clinical history reviewed.. After twelve years of medical consults, lepromatous leprosy was diagnosed, based on perforation of her nasal septum, with a bacterial index of 5. Her husband and a 12-year-old daughter have leprosy symptoms. During multidrug therapy, she presented with repeated type 2 lepra reaction episodes for which she received daily clofazimine 400 mg doses. Two months after this treatment, severe and frequent episodes of intense abdominal pain began to occur. These persisted for more than a year and were managed with in-hospital administration of several classes of painkillers and antispasmodic medication, including morphine. She also presented with sporadic diarrhea, constipation, nausea, weight loss and mesenteric adenopathies. She died finally due to this intestinal condition. No autopsy was performed.. The patient's clinical presentation suggested a clofazimine-induced lethal enteropathy, a complication not previously seen in Colombia. This connection was not recognized by the medical officers that treated the patient.

Topics: Abdominal Pain; Adult; Arthritis, Rheumatoid; Child; Child, Preschool; Clofazimine; Constipation; Diagnostic Errors; Diarrhea; Drug Therapy, Combination; Erythema Nodosum; Family Health; Fatal Outcome; Female; Humans; Intestinal Diseases; Leishmaniasis, Mucocutaneous; Leprostatic Agents; Leprosy, Lepromatous; Male; Paresthesia; Pregnancy; Pregnancy Complications, Infectious; Rifampin

Topics: Abdominal Pain; Adult; Animals; Brucella; Brucellosis; Calcinosis; Combined Modality Therapy; Doxycycline; Drug Therapy, Combination; Fever; Food Contamination; Food Microbiology; Hepatectomy; Humans; Liver Abscess; Male; Milk; Recurrence; Rifampin

To present a case of successful emergency endovascular repair of a ruptured, probably mycotic, thoracoabdominal aortic aneurysm (TAAA) with a stent-graft deliberately covering the celiac axis.. A 79-year-old woman with significant pulmonary comorbidity presented with a ruptured mycotic TAAA extending to the celiac axis. The aneurysm was excluded with a stent-graft soaked in rifampicin and deployed to deliberately occlude the celiac axis for effective distal sealing and fixation. The patient recovered well and was prescribed antibiotic treatment for up to 6 months.. Endovascular repair of a ruptured TAAA may be a life-saving option. In emergency situations when poor distal anatomy is present, covering the celiac artery with the stent-graft should be considered.

Topics: Abdominal Pain; Aged; Aneurysm, Infected; Angiography; Angioplasty, Balloon; Anti-Bacterial Agents; Antibiotics, Antitubercular; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Aortic Rupture; Blood Vessel Prosthesis Implantation; Celiac Artery; Diarrhea; Emergencies; Fatigue; Female; Fever; Humans; Patient Selection; Prosthesis Design; Rifampin; Stents; Tomography, X-Ray Computed; Treatment Outcome

We report a case pf pseudomembranous colitis that developed in a patient with tuberculous abdominal lymphadenopathy during treatment with rifampicin. The patient had delayed presentation (3 months) after the start of rifampicin. She had one relapse after 2 months that was successfully treated, and she finished her antituberculosis therapy without any further relapses. Awareness of this serious complication of rifampicin therapy should be encountered.

Topics: Abdominal Pain; Adult; Biopsy, Needle; Colonoscopy; Dose-Response Relationship, Drug; Drug Administration Schedule; Enterocolitis, Pseudomembranous; Female; Follow-Up Studies; Humans; Immunohistochemistry; Metronidazole; Rifampin; Treatment Outcome; Tuberculosis, Lymph Node

Topics: Abdominal Pain; Antibiotics, Antitubercular; Antitubercular Agents; Diagnosis, Differential; Drug Therapy, Combination; Humans; Isoniazid; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Middle Aged; Prognosis; Radiography, Abdominal; Rifampin; Tomography, X-Ray Computed; Tuberculosis, Miliary