Journal article
Hypersensitivity reaction with multi-organ failure following re-exposure to rifampicin: case report and review of the literature including WHO spontaneous safety reports.
- Brockhaus L Department of Infectious Diseases, University Hospital Basel, Basel, Switzerland. lisa.brockhaus@unibas.ch.
- Schmid Y Department of Clinical Pharmacology & Toxicology, University Hospital Basel, Basel, Switzerland.
- Rast AC Allergy Unit, Department of Dermatology, University Hospital Basel, Basel, Switzerland.
- Rätz Bravo AE Department of Clinical Pharmacology & Toxicology, University Hospital Basel, Basel, Switzerland.
- Hofmeier KS Allergy Unit, Department of Dermatology, University Hospital Basel, Basel, Switzerland.
- Leuppi-Taegtmeyer AB Department of Clinical Pharmacology & Toxicology, University Hospital Basel, Basel, Switzerland.
- 2019-02-14
Published in:
- BMC pharmacology & toxicology. - 2019
Hypersensitivity reaction
Multi-organ failure
Pharmacovigilance
Pneumonitis
Rifampicin
Aged
Antibiotics, Antitubercular
Drug Hypersensitivity
Humans
Male
Multiple Organ Failure
Rifampin
English
BACKGROUND
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.
CASE PRESENTATION
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.
CONCLUSIONS
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.
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.
CASE PRESENTATION
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.
CONCLUSIONS
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.
- Language
-
- English
- Open access status
- gold
- Identifiers
-
- DOI 10.1186/s40360-019-0289-7
- PMID 30755272
- Persistent URL
- https://sonar.ch/global/documents/232386
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