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Table 1 Comparison of reactions in our patient after exposure to rifampicin in 1994, 2008 and 2017

From: Hypersensitivity reaction with multi-organ failure following re-exposure to rifampicin: case report and review of the literature including WHO spontaneous safety reports

  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
  1. CRRT Continuous renal replacement therapy