rifampin and Multiple-Organ-Failure

True hypersensitivity reactions to rifampicin are relatively rare, nonetheless severe manifestations mostly involving a single organ have been documented. We report a case of acute multi-organ failure occurring after a medication error with re-exposure to rifampicin.. A 68-year old patient developed acute hypersensitivity pneumonitis, acute renal failure, acute liver failure and haemolytic anemia within hours after a second re-exposure to Rifampicin for the treatment of a hip prosthesis infection with Staphylococcus epidermidis. A recent rifampicin exposure 1 week earlier had resulted in a massive rise of CRP levels without organ manifestations. Nine years previously, the patient had developed a multi-organ hypersensitivity reaction 8 days after commencing treatment with rifampicin for pulmonary tuberculosis; and 23 years previously he had received rifampicin without problems. The organ-specific hypersensitivity reactions were largely reversible after withdrawal of rifampicin and treatment with steroids. A review of the literature and summary of WHO spontaneous safety reports is also given.. Re-exposure to rifampicin in sensitised individuals may cause acute severe hypersensitivity reactions. Due to its indications in the management of mycobacterial and implant-associated infections, rifampicin is a drug which might be given decades apart, which poses a risk that information about previous intolerance is lost.

Topics: Aged; Antibiotics, Antitubercular; Drug Hypersensitivity; Humans; Male; Multiple Organ Failure; Rifampin

Topics: Administration, Intravenous; Aged; Amanita; Amanitins; Antitoxins; Female; Humans; Male; Multiple Organ Failure; Mushroom Poisoning; Rifampin; Treatment Outcome

Topics: Antibodies, Monoclonal, Humanized; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Middle Aged; Multiple Organ Failure; Mycobacterium tuberculosis; Pyrazinamide; Rifampin; Sepsis; Treatment Outcome; Tuberculosis

Topics: Antitubercular Agents; Combined Modality Therapy; Drug Combinations; Drug Hypersensitivity Syndrome; Ethambutol; Glucocorticoids; Herpesvirus 6, Human; Humans; Isoniazid; Leukapheresis; Male; Multiple Organ Failure; Plasmapheresis; Pyrazinamide; Rifampin; Roseolovirus Infections; Tuberculosis, Pleural; Young Adult

It is well known that disseminated Mycobacterium bovis BCG infection is developed after BCG vaccination in infants with congenital cellular immune deficiencies such as mutations in genes along the interleukin (IL)-12/interferon (IFN)-γ pathway and mutations in nuclear factor-kB essential modulator (NEMO). In this report, a rifampicin-resistant M.bovis BCG strain isolated from an infant with NEMO defect was presented. An 8-month-old male infant with NEMO defect admitted to the pediatric outpatient clinic of our hospital with fever, generalized lymphadenopathy and hepatosplenomegaly. Microscopic examination of the smears prepared from lymph node and liver biopsy specimens revealed abundant amount (3+) of acid-fast bacilli (AFB). Rifampicin-susceptible Mycobacterium tuberculosis complex (MTC) was detected by real-time PCR (GeneXpert MTB/RIF; Cepheid, USA) in the samples. The growth of mycobacteria was determined on the 20th day of culture performed in MGIT960 system (Becton Dickinson, USA). The isolate was identified as M.bovis BCG by GenoType MTBC kit (Hain Lifescience, Germany) and defined as M.bovis BCG [SIT 482 (BOV_1)] by spoligotyping. In the primary anti-tuberculosis drug susceptibility test performed by MGIT960 system, the isolate was found susceptible to rifampicin (RIF), isoniazid (INH), streptomycin (STM) and ethambutol (EMB). Then anti-tuberculosis treatment was started to the patient. However, the patient at the age of 2 years, re-admitted to the hospital with the complaint of hepatosplenomegaly. Smear of spontaneously draining abscess material obtained from subcutaneous nodules revealed intensive AFB positivity (3+) once again. In the present instance RIF-resistant MTC was detected with GeneXpert system in the specimen. The growth of mycobacteria was determined on the 13th day of culture and isolate was identified as M.bovis BCG. The present isolate was found susceptible to INH, STM and EMB but resistant to RIF. A mutation in the rpoB gene (codon 531, S531L) associated with RIF resistance was detected by using the partial sequencing of the rpoB gene. Patient died due to disseminated bovis BCG infection and multiple organ failure. To our knowledge, there are only six RIF-resistant M.bovis BCG strains isolated from patients in the literature. However, this is the first RIF-resistant M.bovis BCG strain isolated from a NEMO-deficient patient.

Topics: Antibiotics, Antitubercular; Bacterial Proteins; DNA-Directed RNA Polymerases; Drug Resistance, Bacterial; Ectodermal Dysplasia; Fatal Outcome; Genetic Diseases, X-Linked; Humans; Immunologic Deficiency Syndromes; Infant; Liver; Lymph Nodes; Male; Multiple Organ Failure; Mutation; Mycobacterium bovis; Primary Immunodeficiency Diseases; Rifampin; Tuberculosis

We report a case of a 15-year-old boy who developed multiple organ failure secondary to a sport injury leading to infection with a Panton Valentine Leukocidin (PVL) secreting Community-Acquired Methicillin Sensitive Staphylococcus Aureus (CA MSSA). Aggressive antibiotic therapy eventually led to recovery.

Topics: Adolescent; Anti-Bacterial Agents; Antibiotics, Antitubercular; Anticoagulants; Athletic Injuries; Bacterial Toxins; Community-Acquired Infections; Exotoxins; Floxacillin; Humans; Leukocidins; Male; Martial Arts; Methicillin Resistance; Multiple Organ Failure; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Warfarin

Topics: Aged; Erythromycin; Humans; Legionnaires' Disease; Male; Middle Aged; Multiple Organ Failure; Radiography, Thoracic; Rifampin