Rifampin-Related Acute Renal Failure, Thrombocytopenia, and Leukocytoclastic Vasculitis

Abstract

Rifampin-Related Acute Renal Failure, Thrombocytopenia, and Leukocytoclastic Vasculitis TOTHE EDITOR: Rifampin is a first-line drug in the treatment of Mycobacteriumkansasii. Acute renal failure and thrombocytopenia due to rifampinhave been reported sporadically.P and a case presenting witha skin lesion suggestiveof vasculitis has been described.'This is the first case in which rifampin administration was followedby these 3 adverse reactions concurrently in the same patient.withhistological confirmation of a vasculitic lesion.Case Report. A 76-year-oldman with a past historyof stableangina pectoris treated with aspirin was transferred to our hospitalwith a oneweek historyof fever,dry cough,dyspnea,oliguria.and bilateraledema in lowerextremities. 1\vo monthsearlierthe patienthad been diagnosed with M. kansasii pulmonary disease and was treated with a combined preparation of isoniazid 50 mg, rifampin 120mg, and pyrazinamide 300 mg (Rifater). He was taking 5 tablets daily (total daily dose: isoniazid 250 mg, rifampin 600 mg, pyrazinamide 1500mg). At that time,laboratory parameters included hemoglobin 15.3 g/dL, white blood cell (WBC) count 7540ljlL. platelets 232 x IDlljlL, serum creatinine 1.1 mg/elL, and urea56 mg/elL.On the patient'sadmission, laboratory data showedacute renalfailure (serum creatinine 9.6 mg/dL, urea 168 mg/dL) and thrombocytopenia (platelets85 x IDlljlL). Other results were WBC count 13,3oo/jlL,he-This is, to the bestof our knowledge,the first reportedcase of histologically confirmed rifampin-induced leukocytoclastic vasculitis. Iredale • et al. l reported on a patientwitha skinlesionsuggestive of vasculitis, but therewas no histological confirmation. Use of the Naranjoprobability scale indicated a probable relationship betweenrifampin and acute renalfailure,thrombocytopenia, and leukocytoclastic vasculitis.' This case has beenreported to the SpanishHealth Authorities (number 07-121).

Ceftriaxone-induced leukocytoclastic vasculitis: a case report and literature review of antibiotic-induced leukocytoclastic vasculitis

“…A total of 60 published articles were included, comprising a total of 74 cases published between 1955 and 2021 (Table 1). 20,26,27,30 –86 Analyses of the reported cases of antibiotic-induced leukocytoclastic vasculitis revealed that it is associated with numerous classes of antibiotic, including penicillin (amoxicillin, amoxicillin-clavulanic acid, oxacillin), cephalosporins (cefazolin, cephalexin, cefuroxime, ceftriaxone, cefotaxime), fluoroquinolone (ciprofloxacin, levofloxacin, ofloxacin), macrolides (azithromycin, clarithromycin), vancomycin, teicoplanin, trimethoprim-sulfamethoxazole, dapsone, linezolid, pristinamycin, tigecycline, isoniazid, streptomycin, rifampin, ethambutol, and pyrazinamide.…”