Recurrent disseminated intravascular coagulation caused by intermittent dosing of rifampin

Abstract

Daily rifampin therapy is associated with minimal adverse effects, but administration on an intermittent or interrupted basis has been associated with severe immunoallergic reactions such as hemolytic anemia, acute renal failure, and disseminated intravascular coagulation. We describe a patient with Mycobacterium leprae infection who experienced recurrent episodes of disseminated intravascular coagulation after intermittent exposures to rifampin, and review eight previously reported cases of rifampin-associated disseminated intravascular coagulation. In six (75%) cases, previous exposure to rifampin was reported and seven (87.5%) patients were receiving the medication on an intermittent or interrupted basis. Clinical features of rifampin-associated disseminated intravascular coagulation included fever, hypotension, abdominal pain, and vomiting within hours of ingestion. Average time to reaction was 3-6 doses if rifampin was being administered on a monthly schedule. Three (37.5%) of eight reported cases were fatal. A complete history of previous exposure to rifampin is recommended before intermittent therapy with this medication.

Figure 1.

Time plots for trends in laboratory parameters over four episodes of immunoallergic reactions to rifampin in a 66-year-old woman for A, hemogloblin concentration; B, platelet count. C, creatinine; D, prothrombin time; E, international normalized ratio; and F, fibrinogen levels. Black arrows indicate times of ingestion of rifampin.