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6.
Medicine (Baltimore) ; 96(7): e6135, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-28207542

RESUMEN

RATIONALE: Disseminated intravascular coagulation (DIC) induced by daily rifampicin therapy is rare, especially the patient is absent of malignancy, severe infection, and prior exposure to rifampicin. PATIENT CONCERNS: We report a case of DIC induced by daily rifampicin treatment for pulmonary tuberculosis. A 22-year-old, previously healthy man received an anti-tuberculosis therapy consisting of isoniazid, rifampicin, ethambutol, and pyrazinamide on the daily dose recommended by the World Health Organization tuberculosis guidelines after a diagnosis of pulmonary tuberculosis. Two weeks later, he was transferred to the West China Hospital with nasal hemorrhage for 1 week, hematochezia, hematuria, and petechiae for 5 days. DIAGNOSES: Laboratory data and symptoms on admission indicated DIC. INTERVENTIONS: The anti-tuberculosis drugs were discontinued after admission and he was initiated with targeted treatment for DIC, omeprazole and polyene hosphatidylcholine infusion, as well as nutrition supportive treatment. Five days after admission, ethambutol, moxifloxacin, and amikacin were added to the patient without further active hemorrhage. Eight days after admission, the platelet count had risen gradually. Isoniazid was administered on 24 days after admission, while his liver function tests and platelet counts returned to normal. No recurrence of DIC occurred. The diagnosis of rifampicin-induced DIC was confirmed. OUTCOMES: The patient recovered and left hospital with isoniazid, ethambutol, levofloxacin, and streptomycin after 4 weeks of hospitalization. There was no recurrence of DIC or hemorrhage during the 8 months of follow-up. The literature review revealed that there were 10 other cases of rifampicin-induced DIC. Only 4 cases received rifampicin on a daily basis for pulmonary tuberculosis treatment and the others were on intermittent dosing schedule for pulmonary tuberculosis or leprosy treatment. LESSONS: As a rare adverse effect, DIC induced by rifampicin occurs irregularly and unpredictably, which is reported to be more associated with the intermittent usage of rifampicin, but can occur with rifampicin daily administration. Identification of early symptoms, drug discontinuation, supportive management, and regular monitoring are the key points to correct this adverse effect, which may contribute to severe even fetal results in patients and deserves more attention.


Asunto(s)
Antituberculosos/efectos adversos , Coagulación Intravascular Diseminada/inducido químicamente , Rifampin/efectos adversos , Tuberculosis Pulmonar/tratamiento farmacológico , Antituberculosos/uso terapéutico , China , Coagulación Intravascular Diseminada/complicaciones , Hemorragia Gastrointestinal/etiología , Hematuria/etiología , Humanos , Masculino , Púrpura/etiología , Rifampin/uso terapéutico , Adulto Joven
8.
Artículo en Inglés | MEDLINE | ID: mdl-17179619

RESUMEN

We report two male patients who presented with symmetrical, painful purpura that evolved into bullae and necrotic ulcers, predominantly on the extremities, over two months in spite of conventional therapy including oral steroids. Examination showed livedoid and purpuric patches with necrotic centers in starburst pattern over the extremities and buttocks. The first case also had similar lesions over the ears. The clinical presentation and the histopathological examination suggested a diagnosis of necrotizing leukocytoclastic vasculitis (LCV). Blood testing ruled out connective tissue disease, hepatitis B or C infection or streptococcal infection as underlying cause of vasculitis. Serum antinuclear factor, antineutrophilic cytoplasmic antibody and anticardiolipin anticoagulant were negative in both cases. Cryoglobulins were positive in case 2. An incidental finding was raised serum proteins and globulins in case 2. Further investigations revealed M band on electrophoresis and features of multiple myeloma on bone marrow biopsy in both cases. These cases emphasize the importance of simple investigations like serum proteins in the evaluation of LCV.


Asunto(s)
Mieloma Múltiple/complicaciones , Piel/irrigación sanguínea , Vasculitis Leucocitoclástica Cutánea/etiología , Adulto , Biopsia , Proteínas Sanguíneas/análisis , Médula Ósea/patología , Nalgas , Oído Externo/irrigación sanguínea , Electroforesis , Extremidades , Humanos , Masculino , Persona de Mediana Edad , Mieloma Múltiple/patología , Púrpura/etiología , Vasculitis Leucocitoclástica Cutánea/sangre
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