Rifampicin
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Increased transaminases, hyperbilirubinaemia and thrombocytopenia: case report A 60-year-old man developed increased transaminases, hyperbilirubinaemia and thrombocytopenia during treatment with rifampicin for miliary tuberculosis. The man, whose medical history was notable for ulcerative colitis, presented with night sweats accompanied by anorexia and weight loss. Subsequent analyses led to the diagnosis of miliary tuberculosis. Therefore, he started receiving first-line antitubercular therapy with rifampicin [route and dosage not stated], isoniazid, pyrazinamide and ethambutol. However, on day 15 of the therapy, laboratory results showed hyperbilirubinaemia (total bilirubin 2.15 mg/dL) and elevated transaminases (AST 329 U/L and ALT 270 U/L), which were attributed to rifampicin. The man’s antitubercular therapy was temporarily withheld, and his laboratory values normalised. The man’s antitubercular medications were subsequently reintroduced sequentially. Amikacin, levofloxacin and pyrazinamide were introduced first; amikacin was subsequently discontinued and replaced with ethambutol, and finally, rifampicin was added. However, approximately 6 days following the re-introduction of rifampicin, he experienced an abrupt drop in platelet count (from 241 × 103/µL to 2 × 103/µL), with associated epistaxis. Antiplatelet antibody test was found to be negative. After ruling out all other possible causes, the severe thrombocytopenia was attributed to rifampicin, and rifampicin was discontinued. He received platelet transfusion and methylprednisolone pulses, resulting in normalisation of his platelet count. He continued receiving levofloxacin, isoniazid, pyrazinamide and ethambutol. Later, Mycobacterium tuberculosis complex isolated from his sputum showed resistance to isoniazid and pyrazinamide; hence, his regimen was changed to levofloxacin, ethambutol, clofazimine and cycloserine for 12 months. Mauricio J, et al. Severe rifampicin-induced thrombocytopenia in a patient with miliary tuberculosis. Pulmonology 26: 247-249, No. 4, Aug 2020. Available from: URL: http:/ 803501533 /doi.org/10.1016/j.pulmoe.2019.09.005
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Reactions 19 Sep 2020 No. 1822
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