Table 1 Comparison of reactions in our patient after exposure to rifampicin in 1994, 2008 and 2017
1994 | 2008 | 2017 | |
|---|---|---|---|
Rifampicin dose | Rifampicin 700 mg/d p.o. Duration of therapy unknown | Rifampicin 700 mg/d p.o. for 8 days | Rifampicin 900 mg/d p.o. for 2.5 days, stop 6 days, followed by a single oral dose of 450 mg. |
Indication for rifampicin | Pulmonary tuberculosis | Pulmonary tuberculosis | Hip prosthesis infection with S. epidermidis |
Adverse drug reactions (ADR) | None | • Systemic inflammatory reaction • Immune-mediated hemolytic anemia • Mild thrombocytopenia • Interstitial nephritis (biopsy proven) with oligoanuric renal failure requiring CRRT • Transient liver enzyme elevation (AST 10 x ULN, ALT normal) | • CRP-increase from ca. 90 to 450 mg/l after first exposure episode • Systemic inflammatory reaction • Immune-mediated hemolytic anemia • Mild thrombocytopenia • Nephritis with oligoanuric renal failure requiring CRRT • Acute liver injury (AST 330 x ULN, ALT 30 x ULN) • Pneumonitis |
Latency time | 8 days | < 1 day | |
Management | • Rifampicin stopped • CRRT | • Rifampicin stopped • Systemic corticosteroids, tapered over 2 months • CRRT | |
Outcome | Recovery within 2 weeks | Clinical recovery within 2 months | |
Lymphocyte transformation test | Negative 2 weeks after exposure | Positive 3 weeks after exposure |