rifampin and Dermatomyositis

A 58-year-old female with a history of dermatomyositis was receiving large oral doses of steroids. She had pulmonary tuberculosis and developed a fever, systemic exudative erythema, exanthema, and epidermolysis covering 30% of her body surface area while being treated with four agents, including isoniazid (INH) and rifampicin (RFP). Histopathologically, eosinophilic necrosis was observed in all layers of the epidermis and a diagnosis of Stevens-Johnson syndrome (SJS) progressive toxic epidermal necrolysis (TEN) was made. The drugs suspected in the drug-induced lymphocyte stimulation test (DLST) re-testing were INH and RFP, and the DLST was considered to be important during the recovery period as well as in the acute phase. Early treatment with plasma exchange therapy and large quantities of intravenous immunoglobulin (IVIG) was successful. Plasma exchange therapy and IVIG are extremely effective when SJS and TEN occur in a patient already on high-dose steroid therapy. Note that the incidence of SJS and TEN is believed to be higher in patients with collagen disease, such as in our case, as compared to the general population.

Topics: Dermatomyositis; Desensitization, Immunologic; Exanthema; Female; Humans; Immunoglobulins, Intravenous; Isoniazid; Middle Aged; Plasma Exchange; Rifampin; Stevens-Johnson Syndrome; Treatment Outcome; Tuberculosis, Pulmonary

The case of a 56-year-old woman, with a previous history of systemic lupus erythematosus (SLE), later diagnosed as also affected by active dermatomyositis (DM) associated with tuberculosis (TB) is reported. Since TB is a contra-indication to receive immunosuppressive therapy for DM/SLE, intravenous immunoglobulins (IVIG) with low-dose steroids and anti-TB therapy were administered with excellent clinical results. This report underlines the crucial role of IVIG in the treatment of critical patients suffering from connective tissue disorders associated with severe infections.

Topics: Antitubercular Agents; Dermatomyositis; Female; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Isoniazid; Lupus Erythematosus, Systemic; Middle Aged; Pyrazinamide; Rifampin; Tuberculosis

The authors report two cases of muscular tuberculosis in patients with dermatomyositis treated with steroids. Antituberculous therapy with Rifampicin led to a severe relapse of the dermatomyositis in both cases, suggesting enzymatic induction inhibiting the action of the steroids.

Topics: Adrenal Cortex Hormones; Dermatomyositis; Humans; Male; Middle Aged; Muscular Diseases; Recurrence; Rifampin; Tuberculosis