rifampin and Disseminated-Intravascular-Coagulation

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

A case of a 73-year-old woman with acute renal failure due to toxic shock syndrome (TSS) is reported. The patient was admitted to our hospital with the complaints of high fever, disturbance of consciousness and shock. Laboratory findings on admission were; CRP 25.11 mg/dl, WBC 35000/ microl, Plt 1.6 x 10(4)/ microl, GOT 155 U/l, GPT 65 U/l, CPK 4202 U/l (CPK-MM 96%), BUN 123 mg/dl and SCr 7.0 mg/dl. Because of anuria, hemodialysis was performed. This patient was treated with dopamine, methyl prednisolone (MP), frozen fresh plasma, AT III, antibiotics, and platelet transfusion. The bacterial cultures of blood and cerebrospinal fluid were negative, but MRSA was isolated subsequently from the pharynx and vagina. We investigated the production of toxic shock syndrome toxin 1 (TSST-1) and staphylococcal enterotoxins (SE). The isolated MRSA produced TSST-1, SEB and SEC. Accordingly, we made the diagnosis of TSS. After improvement of acute renal failure and the patient's general condition, MRSA persisted and TSST-1 was still found in the patient's blood. Finally we eradicated the MRSA and TSST-1 after administration of ciprofloxacin hydrochloride (CPFX) and Rifampicin (RFP).

Topics: Acute Kidney Injury; Aged; Anti-Infective Agents; Antibiotics, Antitubercular; Bacterial Toxins; Ciprofloxacin; Disseminated Intravascular Coagulation; Enterotoxins; Female; Humans; Methicillin Resistance; Rifampin; Shock, Septic; Staphylococcal Infections; Staphylococcus aureus; Superantigens

Rifampicin is currently used to treat various bacterial infections, with the most significant application in the treatment of tuberculosis. Dose-independent side effects of the drug can lead to the development of various coagulation disorders, among which disseminated intravascular coagulation is the most dangerous. The mechanism of coagulopathy itself is multifactorial, but it is thought to be mediated by an immune response (formation of antigen-antibody complexes) and consequent damage to platelets and the vascular endothelium.. A 66-year-old woman, with numerous comorbidities including chronic renal failure, condition after implantation of a permanent pacemaker, and a positive blood culture for Staphylococcus aureus, presented with spontaneous bleeding in the muscle wall, and in the clinical picture of hemorrhagic shock.. Knowing the multifactorial mechanism of rifampicin-induced coagulopathy, possible factors were considered, such as infections, comorbidities, drug use and drug-drug interactions, pathological laboratory parameters, and coagulograms. Clinical presentation of abdominal pain and intra-abdominal mass, with laboratory verification of prolonged activated partial thromboplastin time and computed tomography-proven hematoma suspected of acute bleeding, redirects clinical suspicion of drug-induced coagulopathy.. By discontinuing rifapicin and administering vitamin K and fresh frozen plasma, normalization of laboratory coagulation parameters was achieved. Bleeding from the muscle wall required correction of acute anemia with red cell concentrates, surgical intervention, and additional antibiotic therapy for secondary infection of the operative wound.. At the end of 6 weeks of antibiotic (antistaphylococcal) therapy (due to the basic suspicion of possible infectious endocarditis), the normalization of inflammatory parameters occurred with a sterile control blood culture and a normal coagulogram.. Clinicians should be aware of the possible side effects of the administered drugs, especially taking into account the overall clinical picture of a patient, including comorbidities and possible drug interactions.

Topics: Abdominal Wall; Aged; Anti-Bacterial Agents; Disseminated Intravascular Coagulation; Female; Humans; Plasma; Rifampin; Staphylococcal Infections; Vitamin K

Disseminated intravascular coagulation (DIC) induced by daily rifampicin therapy is rare, especially the patient is absent of malignancy, severe infection, and prior exposure to rifampicin.. We report a case of DIC induced by daily rifampicin treatment for pulmonary tuberculosis. A 22-year-old, previously healthy man received an anti-tuberculosis therapy consisting of isoniazid, rifampicin, ethambutol, and pyrazinamide on the daily dose recommended by the World Health Organization tuberculosis guidelines after a diagnosis of pulmonary tuberculosis. Two weeks later, he was transferred to the West China Hospital with nasal hemorrhage for 1 week, hematochezia, hematuria, and petechiae for 5 days.. Laboratory data and symptoms on admission indicated DIC.. The anti-tuberculosis drugs were discontinued after admission and he was initiated with targeted treatment for DIC, omeprazole and polyene hosphatidylcholine infusion, as well as nutrition supportive treatment. Five days after admission, ethambutol, moxifloxacin, and amikacin were added to the patient without further active hemorrhage. Eight days after admission, the platelet count had risen gradually. Isoniazid was administered on 24 days after admission, while his liver function tests and platelet counts returned to normal. No recurrence of DIC occurred. The diagnosis of rifampicin-induced DIC was confirmed.. The patient recovered and left hospital with isoniazid, ethambutol, levofloxacin, and streptomycin after 4 weeks of hospitalization. There was no recurrence of DIC or hemorrhage during the 8 months of follow-up. The literature review revealed that there were 10 other cases of rifampicin-induced DIC. Only 4 cases received rifampicin on a daily basis for pulmonary tuberculosis treatment and the others were on intermittent dosing schedule for pulmonary tuberculosis or leprosy treatment.. As a rare adverse effect, DIC induced by rifampicin occurs irregularly and unpredictably, which is reported to be more associated with the intermittent usage of rifampicin, but can occur with rifampicin daily administration. Identification of early symptoms, drug discontinuation, supportive management, and regular monitoring are the key points to correct this adverse effect, which may contribute to severe even fetal results in patients and deserves more attention.

Topics: Antitubercular Agents; China; Disseminated Intravascular Coagulation; Gastrointestinal Hemorrhage; Hematuria; Humans; Male; Purpura; Rifampin; Tuberculosis, Pulmonary; Young Adult

Topics: Acute Kidney Injury; Antitubercular Agents; Disseminated Intravascular Coagulation; Drug Therapy, Combination; Female; Humans; Renal Dialysis; Rifampin; Tuberculosis, Pulmonary; Young Adult

Topics: Acute Kidney Injury; Adult; Anaphylaxis; Anemia, Hemolytic; Antibiotics, Antitubercular; Disseminated Intravascular Coagulation; Drug Hypersensitivity; Humans; Hypersensitivity, Immediate; Liver; Male; Renal Dialysis; Rifampin; Treatment Outcome; Tuberculosis, Pulmonary

Disseminated intravascular coagulation (DIC) is a very rare complication of pulmonary tuberculosis. We herein describe a case of cavitary tuberculosis complicated with DIC. Rifampin was considered to deteriorate the clinical course of DIC in this case.

Topics: Adult; Antibiotics, Antitubercular; Disseminated Intravascular Coagulation; Humans; Male; Rifampin; Tuberculosis, Pulmonary

Topics: Disseminated Intravascular Coagulation; Female; Humans; Leprostatic Agents; Leprosy, Lepromatous; Liver; Middle Aged; Necrosis; Rifampin

A case of subclinical disseminated intravascular coagulopathy due to antituberculosis drugs, probably rifampicin, is described. The patient also developed marked leucocytosis, a 'flu-like illness, intravascular haemolysis, and acute renal failure as part of the drug reaction.

Topics: Adult; Disseminated Intravascular Coagulation; Drug Therapy, Combination; Female; Humans; Isoniazid; Rifampin; Tuberculosis, Pulmonary

In a 48-years old woman, intermittent rifampicin treatment induced an immunoallergic reaction with digestive disorders, haemolysis, acute renal failure and prolonged prothrombin time. The reintroduction of rifampicin, 17 days later, resulted in a similar, though more severe, reaction associated with diffuse haemorrhages from disseminated intravascular coagulation, this association being exceptional. The responsibility of rifampicin was demonstrated by the chronological relationship between clinical symptoms and administration of the drug, and by the presence in the patient's serum of anti-rifampicin antibodies. The antigen-antibody reaction with complement activation and haemolysis probably explains the disseminated intravascular coagulation.

Topics: Acute Kidney Injury; Antibodies; Antigen-Antibody Reactions; Complement Activation; Disseminated Intravascular Coagulation; Drug Hypersensitivity; Female; Hemolysis; Humans; Middle Aged; Rifampin

A 53-year-old female patient with ovarian dermatoid cyst and lung tuberculosis had been treated with rifampicin. During repeated rifampicin treatment she developed an acute haemolytic syndrome with haemorrhagic diathesis. Laboratory findings showed that it was caused by disseminated intravascular coagulation. Death ensued despite intensive administration of heparin and Trasylol. It is assumed that the repeated rifampicin application had provoked massive haemolysis by an allergic mechanism leading to thrombofibrinolytic haemorrhagic diathesis.

Topics: Antithrombins; Blood Coagulation; Disseminated Intravascular Coagulation; Female; Hemolysis; Heparin; Humans; Middle Aged; Ovarian Cysts; Rifampin