rifampin and Collagen-Diseases

It were Liebow et al. (1965) who, for the first time, described the desquamative interstitial pneumonia (DIP) as one clinical and morphological unit. The etiopathology of this disease is still unknown and there exist many controversial opinions as to its role within the interstitial pneumonias. For the clinical-physician the DIP represents a difficult problem because there seems to be no uniform appearance to this disease. So a lung-biopsy is the unique way to make a definitive diagnosis. The following description represents a case of DIP observed at our hospital. At the same time we tried to give a review of our present knowledge concerning the morphology, course and therapy of this disease. We think it should be note that the DIP was accompanied by an extreme peripheral eosinophilia. To our knowledge this is the first time such a phenomenon is described. In the course of the treatment with steroids the eosinophilia disappeared parallel to the normalization of the radiographic findings.

Topics: Adrenal Cortex Hormones; Adult; Alveolitis, Extrinsic Allergic; Collagen Diseases; Diagnosis, Differential; Eosinophilia; Female; Histiocytosis, Langerhans-Cell; Humans; Isoniazid; Lung; Pneumonia; Pulmonary Eosinophilia; Radiography; Rifampin; Tetracycline

Although rifampicin (RFP) is known to be one of the potent hepatic microsomal enzyme inducers, little has been reported about the detailed pharmacokinetics of glucocorticoids in patients under RFP therapy. In this paper, the metabolism of cortisol, prednisolone and dexamethasone were investigated comparatively by simultaneous injection of these glucocorticoids. Eleven patients under RFP therapy, including 7 with tuberculosis together with collagen diseases and 4 with tuberculosis alone, were studied. Sixteen normal volunteers and 4 patients with collagen diseases not under RFP therapy were also examined as controls. After 1 mg of betamethasone was administered orally on the previous night for the suppression of endogenous cortisol, a mixed solution of 1 mg each of cortisol, prednisolone and dexamethasone was given intravenously. Plasma steroid levels of periodically collected blood samples were determined by respective radioimmunoassay after extraction with dichloromethane and purification by paper chromatography. Half-times of plasma disappearance (t 1/2), metabolic clearance rates (MCR) and total apparent distribution volumes (V) of these glucocorticoids were calculated using the single compartment model. The mean values of t 1/2 of cortisol, prednisolone and dexamethasone in patients with collagen diseases under RFP therapy were 1.8 +/- 0.3 (Mean +/- SD) (p less than 0.05), 1.4 +/- 0.2 (p less than 0.001) and 1.3 +/- 0.3 hours (p less than 0.001), respectively, which were significantly shortened when compared with normal subjects (cortisol, 2.1 +/- 0.2; prednisolone, 2.5 +/- 0.7; dexamethasone, 3.5 +/- 1.0 hours). The MCR of cortisol, prednisolone and dexamethasone in these patients were 139 +/- 57, 141 +/- 53 (p less than 0.01) and 722 +/- 137 l/day/m2 (p less than 0.001), respectively, which were increased when compared with normal subjects (cortisol, 114 +/- 20; prednisolone, 75 +/- 25; dexamethasone, 153 +/- 45 l/day/m2). The metabolism of these glucocorticoids in patients with collagen diseases under RFP therapy were also accelerated when compared with those in patients with collagen diseases not under RFP therapy. The t 1/2 of cortisol, prednisolone and dexamethasone in patients with tuberculosis alone under RFP therapy were 1.3 +/- 0.3 (p less than 0.001), 1.4 +/- 0.5 (p less than 0.01) and 1.2 +/- 0.3 hours (p less than 0.001), respectively, which were significantly shortened when compared with normal subjects.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Adult; Collagen Diseases; Dexamethasone; Drug Interactions; Female; Humans; Hydrocortisone; Male; Middle Aged; Prednisolone; Rifampin; Tuberculosis, Pulmonary

Topics: Adult; Collagen Diseases; Drug Interactions; Female; Humans; Inactivation, Metabolic; Kinetics; Prednisolone; Rifampin; Tuberculosis, Pulmonary