Abstract
BackgroundTrue 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 presentationA 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.ConclusionsRe-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.
Highlights
True hypersensitivity reactions to rifampicin are relatively rare, severe manifestations mostly involving a single organ have been documented
Allergic reactions to rifampicin, which is routinely used in the treatment of tuberculosis and implant-associated staphylococcal infections [1], are rarely witnessed in clinical practice [2, 3]
We report a case of a severe rifampicin hypersensitivity reaction with multi-organ failure occurring at our clinic after accidental rechallenge and discuss the frequency and relevance of this adverse event
Summary
Re-exposure to rifampicin in sensitised individuals may cause acute severe hypersensitivity reactions.
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