Recurrent Disseminated Intravascular Coagulation Caused by Intermittent Dosing of Rifampin

Abstract

Abstract. 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. CASE REPORTA 66-year-old woman was hospitalized in July 2009 after acute onset of fever, nausea, and vomiting. Her medical history was significant for lepromatous leprosy diagnosed at age 19, for which she had received multiple courses of therapy that included dapsone, rifampin, clofazimine, and thalidomide. Her leprosy remained quiescent on monotherapy with dapsone from 1986 until November 2008. At that time, she was started on the World Health Organization multidrug treatment regimen for leprosy that included ofloxacin, 300 mg orally/day; dapsone, 100 mg orally/day; and rifampin, 600 mg orally/month to alleviate the need for lifetime monotherapy with dapsone. Minocycline, 50 mg orally/day was substituted for ofloxacin after development of diarrhea. Other medical history included pulmonary tuberculosis diagnosed at age 37 that was treated with multidrug therapy including rifampin, cirrhosis secondary to hepatitis B virus infection for which she was receiving lamivudine, papillary thyroid cancer, bipolar affective disorder, and type II diabetes mellitus.On July 21, 2009, she ingested her ninth monthly dose of rifampin as part of her intermittent dosing regimen. Within three hours, she experienced sudden onset of fever, nausea, and hematemesis and came to the Emergency Department. On examination, her blood pressure was 81/38 mm of Hg, her heart rate was 130/minute, and her temperature was 39.0˚C. She was icteric. There was bleeding from the nares, oral cavity, urinary tract, and venipuncture sites. There was mild tenderness to palpation of the abdomen.Laboratory investigations obtained within 12 hours of admission were compatible with disseminated intravascular coagulation (DIC): international normalized ratio = 3.33 (reference = 0.8-1.2); prothrombin time = 80 seconds (reference = 26-28 seconds); fibrinogen < 1.5 g/L (reference = 1.5-3.50 g/L), and D-dimers > 4,000 mg/L (refere...

Necrose tubular aguda e anemia grave após uso intermitente de rifampicina

“…plexos RFP-anticorpo que, ou se ligam ao complemento no sangue, ou são primeiro absorvidos pela membrana dos glóbulos vermelhos e plaquetas, ativando de seguida o complemento e levando à destruição das células, provocando anemia e trombocitopenia imunes 2,12 . A exposição aos constituintes dos eritrócitos destruídos, leva à ativação da cascata de coagulação 2 .…”

“…A exposição aos constituintes dos eritrócitos destruídos, leva à ativação da cascata de coagulação 2 . A abordagem da CID induzida pela RFP consiste na suspensão do fármaco e transfusão de plaquetas, concentrados de eritrócitos e plasma 2,12 .…”

“…A RFP foi inicialmente desenvolvida para tratar a tuberculose, mas, mais recentemente, tem sido usada contra outras bactérias 1 , podendo ser administrada diariamente ou num esquema intermitente 2,3 . Quando a RFP é administrada de forma diária, os possíveis efeitos adversos incluem reações alérgicas mediadas por IgE, erupções cutâneas, desconforto gastrointestinal, hepatotoxicidade, e interações medicamentosas, mas quando administrada de forma intermitente pode produzir efeitos adversos mais graves conhecidos como reações imunomediadas por IgG e IgM, dirigidas contra os eritrócitos, plaquetas e outras células alvo que expressam o antigénio "I" do sangue, incluindo as células epiteliais tubulares renais 2 .…”

“…A administração RFP, mesmo em doses pouco usuais, de forma intermitente ou diária, pode resultar na sensibilização com um aumento rápido no título de anticorpos após a exposição repetida ao fármaco 2 . O tratamento com uma única dose de RFP pode induzir sensibilização, resultando em reações imuno-alérgicas após reexposição, enquanto a administração diária de RFP poderá conferir tolerância imunológica contra estas reações 2 .…”

Rifampicin-associated acute renal failure and hemolysis: a rather uncommon but severe complication

“…5,6 It has also been reported in the setting of leprosy, 7 staphylococcal endocarditis 8 and infection with nontuberculous mycobacteria. 9 ARF is postulated to be the result of immunologically mediated tubulointerstitial injury.…”