rifampin and Anemia--Hemolytic--Autoimmune

A case is reported of hemolytic anemia following rifampicin administration and complicated by acute renal failure. Furthermore clotting analyses suggested a slight disseminated intravascular coagulation, very likely activated by hemolysis products. Both hemolysis and renal function impairment subsided spontaneously, after the sole withdrawal of rifampin. Direct antiglobulin test became negative within a few days, while an indirect Coomb's test was demonstrated persistently with the patient's serum using red blood cells sensitized in vitro with the drug. Otherwise from all reports in the literature, the patient developed an acute hemolytic anemia while on daily therapy and as many as twenty years after a previous treatment with rifampicin. Mechanisms of drug-induced immune hemolytic anemia and acute nephropathy are discussed (formation of drug-antibody complexes, which adhere on the red blood cells surface and are able to fix complement and induce intravascular hemolysis; tubular necrosis due to hemoglobinuria or immuno-mediated interstitial nephritis).

Topics: Acute Kidney Injury; Anemia, Hemolytic, Autoimmune; Bronchitis; Chronic Disease; Drug Therapy, Combination; Female; Humans; Middle Aged; Rifampin; Time Factors

Brucellosis is a rare zoonotic infection caused by small, fastidious Gram-negative coccobacilli of the genus Brucella that may be associated with haemolytic complications including thrombotic microangiopathy and haemolytic anaemia. We describe a patient with culture confirmed brucellosis who presented with malaise, high grade fever, hepatosplenomegaly and Coombs-positive autoimmune haemolytic anaemia. The patient was successfully treated with combination of doxycycline and rifampicin with no further episodes of relapses or haemolysis. Although rare, the possibility of brucellosis should always be kept in mind in patients with risk factors who present with haemolysis and endemic area.

Topics: Adult; Anemia, Hemolytic, Autoimmune; Anti-Bacterial Agents; Brucellosis; Doxycycline; Female; Humans; Rifampin; Ultrasonography

Topics: Aged; Anemia, Hemolytic, Autoimmune; Echocardiography; Erythrocyte Aggregation; Female; Heart Ventricles; Humans; Rifampin

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: Acute Kidney Injury; Anemia, Hemolytic, Autoimmune; Antitubercular Agents; Diagnosis, Differential; Drug Therapy, Combination; Humans; Male; Middle Aged; Nephritis, Interstitial; Rifampin; Tuberculosis, Pulmonary

Topics: Adult; Anemia, Hemolytic, Autoimmune; Antibiotics, Antitubercular; Humans; Male; Nephritis, Interstitial; Rifampin

Topics: Anemia, Hemolytic, Autoimmune; Female; Humans; Middle Aged; Rifampin