Background:
Rifampicin, an antibiotic, is the principal component of the multidrug regimen used in the treatment of pulmonary tuberculosis. Daily use of rifampicin can lead to severe side effects, however, intermittent use is more associated with the occurrence of disseminated intravascular coagulation (DIC). This case report is the first reported case of rifampicin-induced DIC in the United Kingdom, of which the authors are aware. The report aims to highlight the importance of a rarely documented, and potentially fatal side effect of a commonly used drug, as well as outline the treatment of resultant DIC.
Case presentation:
We report a case of a 40-year-old man, of South Asian descent, initially presenting with shortness of breath, cough and fever. The patient had a past medical history of tuberculosis, which had not been fully treated. Computed tomography imaging and chest radiography demonstrated numerous pulmonary nodules. Together with the radiological findings, culture evidence led to a diagnosis of miliary tuberculosis. The patient was initiated on Rifater (isoniazid, rifampicin, pyrazinamide) and moxifloxacin. On day three after initiation of treatment, the patient developed thrombocytopenia (7 × 10 9 /L), and prolongation of APTT (40.5 seconds) and PT (22.7 seconds). Blood film
analysis showed microangiopathic haemolytic anaemia, consistently bilirubin was elevated (58 μmol/L). Other secondary causes were excluded, which ultimately pointedtowards a diagnosis of DIC. Rifampicin was halted, and the patient was trialled on two other regimens to control his tuberculosis. The DIC continued, until novel administration of intravenous immunoglobulin (IVIg), which restored his coagulation screen to normal levels. Rifampicin is considered to be the most likely inducer of DIC in
this case.
Conclusion:
This report adds to the very limited, but significant literature on rifampicin-induced DIC. A thorough history of previous exposure to rifampicin is recommended before initiating an intermittent schedule of the drug. Future administration of rifampicin can potentially be life-threatening and is contraindicated. The report also highlights a novel approach to administering potentially life-saving treatment in the form of IVIg in the circumstance of a rifampicin-induced DIC.