rifampin and Vasculitis

(1) AIN is the most frequent pattern of drug-induced immunologically mediated renal injury. A number of drugs may be responsible for AIN, namely methicillin and other penicillin derivatives, rifampicin, phenindione and sulfonamides. Particular clinical and pathological features often suggest an immune pathogenetic mechanism. IgG anti-TBM and IgE antibodies have been found in only a few cases and it is likely that antibody-mediated and cell-mediated injury may operate in the same patient. (2) Only few examples of drug-induced vasculitis and glomerulonephritis are known, and the pathophysiology of this kind of renal damage is poorly understood.

Topics: Acute Kidney Injury; Antigens; Basement Membrane; Drug Hypersensitivity; Glafenine; Glomerulonephritis; Humans; Kidney; Kidney Glomerulus; Kidney Tubules; Methicillin; Nephritis, Interstitial; Penicillin G; Penicillins; Phenindione; Rifampin; Sulfonamides; Vasculitis

Infective endocarditis is associated with a variety of clinical signs, but its association with multisystem vasculitis is rarely reported. A high index of suspicion is necessary to differentiate a primary autoimmune vasculitis from an infectious cause as the wrong treatment can lead to significant morbidity and mortality. We present a 71-year-old female patient with negative blood cultures, on antibiotics for recent bacteraemia, who presented with cutaneous and renal leucocytoclastic vasculitis. Workup revealed a vegetation adjacent to her right atrial pacemaker lead consistent with infective endocarditis and her vasculitis completely resolved with appropriate antibiotics.

Topics: Acute Kidney Injury; Aged; Anti-Bacterial Agents; Antibodies, Antineutrophil Cytoplasmic; Bacteremia; Ceftriaxone; Endocarditis, Bacterial; Female; Humans; Pulmonary Edema; Renal Dialysis; Respiratory Insufficiency; Rifampin; Skin Diseases, Vascular; Staphylococcal Infections; Vasculitis

Topics: Adult; Biopsy; Clofazimine; Diagnostic Errors; Female; Humans; Leprostatic Agents; Mycobacterium; Mycobacterium Infections, Nontuberculous; Ofloxacin; Peripheral Nervous System Diseases; Rifampin; Skin; Vasculitis

Cutaneous vasculitis is a clinical entity with a broad differential diagnosis, including an adverse drug reaction. It is defined as inflammation of skin blood vessel walls. During a 7-year-period, we observed three patients who developed isolated cutaneous vasculitis during antibiotic therapy of bacterial infection. All were treated with a fluoroquinolone (ciprofloxacin or levofloxacin) combined with rifampin (two cases) or flucloxacillin (three cases), respectively. In all three cases the lesions gradually resolved after treatment with the inciting fluoroquinolone had been stopped. In one patient, leukocytoclastic small-vessel vasculitis was histologically confirmed. Fluoroquinolone-associated cutaneous vasculitis consists of an isolated self-limiting disorder that is part of a systemic vasculitis, or even life-threatening disease. Clinicians should be aware of this serious adverse event because any continuation of treatment may be fatal.

Topics: Aged; Anti-Bacterial Agents; Bacterial Infections; Drug Therapy, Combination; Floxacillin; Fluoroquinolones; Humans; Male; Rifampin; Skin Diseases; Vasculitis; Withholding Treatment

We report the case of a 58-year-old female who presented with productive cough, weight loss, pulmonary nodular infiltrates and cavitations. She had a positive anti-neutrophil cytoplasmic antibodies (ANCA) test. A diagnosis of vasculitis was considered and a video-assisted thoracoscopic biopsy of the lung nodules was organised. However, prior to the biopsy, the sputum results revealed the presence of acid-fast bacilli, which were identified as Mycobacterium avium complex. A repeat ANCA assay was positive for atypical ANCA with negative proteinase-3 and myeloperoxidase titres. The patient was treated with rifampicin, ethambutol and clarithromycin with clinical and radiological improvement. The objective of this report is to highlight a rare association between positive ANCA titres and a non-tuberculous mycobacterial infection as a misdiagnosis and treatment of this patient with immunosuppressive therapy might have led to serious consequences.

Topics: Antibiotics, Antitubercular; Antibodies, Antineutrophil Cytoplasmic; Biopsy; Clarithromycin; Diagnosis, Differential; Drug Therapy, Combination; Ethambutol; Female; Humans; Lung; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Rifampin; Sputum; Thoracic Surgery, Video-Assisted; Tuberculosis, Pulmonary; Vasculitis

Topics: Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents; Ceftriaxone; Dexamethasone; Floxacillin; Gentamicins; Humans; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Methylprednisolone; Rifampin; Staphylococcal Infections; Vasculitis

We report a patient with lepromatous leprosy who developed a rare variant of type-2 lepra reaction, characterized by pustular lesions, on switching from WHO multi drug therapy (MDT) to ofloxacin-aided MDT.

Topics: Abscess; Adult; Drug Resistance, Bacterial; Drug Therapy, Combination; Erythema Nodosum; Humans; Leprostatic Agents; Leprosy, Lepromatous; Macrophages; Male; Melanins; Minocycline; Mycobacterium tuberculosis; Neutrophils; Ofloxacin; Rifampin; Tumor Necrosis Factor-alpha; Vasculitis

Topics: Aged; Antitubercular Agents; Female; Humans; Middle Aged; Purpura; Rifampin; Skin; Tuberculosis, Pulmonary; Vasculitis

A patient with rheumatoid arthritis developed ulcerated nodules predominantly on his legs. Skin biopsy and culture demonstrated rheumatoid vasculitis and infection with Mycobacterium haemophilum. Improvement was not seen until clarithromycin was added to his treatment regimen.

Topics: Aged; Arthritis, Rheumatoid; Ciprofloxacin; Clarithromycin; Drug Therapy, Combination; Humans; Male; Mycobacterium Infections, Nontuberculous; Prednisone; Rifampin; Skin; Vasculitis

Topics: Adult; Female; Glomerulonephritis; Humans; Rifampin; Skin Diseases, Vascular; Vasculitis