Rifampicin
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Pancytopenia, fever and elevated liver enzyme levels: case report A 30-day-old girl developed fever, pancytopenia and elevated liver enzyme level during treatment with rifampicin for congenital tuberculosis. The girl, who was born via spontaneous vaginal delivery, had mild fever and irritability. After delivery, her mother was diagnosed with tuberculosis. Based on her mother’s history and laboratory findings, a diagnosis of congenital tuberculosis was made. Subsequently, she started receiving treatment with rifampicin [route and dosage not stated], along with pyrazinamide, isoniazid and ethambutol. Afterwards, she was discharged from the hospital. At the age of 30 days, she was re-hospitalised because of a fever, which was started in the previous evening. She had no other symptoms. Her laboratory test results revealed anaemia, thrombocytopenia and low WBC count. Her sepsis workup was unremarkable. The brain MRI showed no evidence of meningitis, while abdominal MRI revealed hepatosplenomegaly and mesenteric lymph nodes enlargement. Her serum AST, cystatin C and ALT levels were elevated. Her serum bilirubin level was 56 µmol/L (conjugated was 42 µmol/L) and LDH was 15 µmol/L. Additionally, the Coombs test showed negative results, while the interferon-γ release assay showed positive results. During hospitalisation, her fever spikes persisted. However, her condition was stable. Her CRP, interleukin-2 receptor, triglyceride and ferritin levels were high. Differential diagnosis of haemophagocytic lymphohistiocytosis was ruled out due to her clinical presentation. Therefore, a diagnosis of pancytopenia, elevated liver enzyme levels and fever associated with rifampicin was made [duration of treatment to reactions onsets not stated]. Hence, the girl’s treatment with rifampicin was changed to levofloxacin. Her fever was resolved spontaneously before the initiation of levofloxacin. Afterwards, her laboratory parameters also improved. The girl’s initial combination therapy with rifampicin was re-started after four days. She had no complications. At the age of 36 days, she was discharged from the hospital. Her therapy with pyrazinamide and ethambutol was stopped after 8 and 6 weeks of treatment, while rifampicin and isoniazid were continued for a total of 9 months. At follow-up, she completely recovered from the infection. Varimo T, et al. A case of congenital tuberculosis with a favorable outcome in a full term neonate. Clinical Case Reports 8: 1802-1805, No. 9, Sep 2020. Available from: 803505634 URL: http://doi.org/10.1002/ccr3.2988
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Reactions 10 Oct 2020 No. 1825
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