Rifampicin induced shock during re-exposure for treatment of latent tuberculosis.
Christopher Francis HarlowJamilah MeghjiLaura MartinTimothy HarrisOnn Min KonPublished in: BMJ case reports (2020)
We present a case of a young Asian female with rheumatoid arthritis who received latent tuberculosis infection (LTBI) treatment prior to treatment with a biologic agent, and developed shock with resistant hypotension on re-exposure to rifampicin. We discuss the epidemiology, pathophysiology and management of rifampicin induced shock, concluding that clinicians should be aware of this rare, but potential adverse effect, and be aware that adverse reactions to rifampicin are more frequent during re-exposure or longer dosing interval regimes. The evidence for desensitisation following such a reaction is lacking and this approach is not currently recommended. We would suggest close collaboration between specialties prescribing immunosuppression and the tuberculosis team when LTBI treatment is required after a reaction, with patient involvement to discuss the risks and benefits of treatment options.
Keyphrases
- mycobacterium tuberculosis
- rheumatoid arthritis
- pulmonary tuberculosis
- primary care
- emergency department
- palliative care
- adverse drug
- oxidative stress
- diabetic rats
- hiv aids
- combination therapy
- endothelial cells
- disease activity
- hepatitis c virus
- systemic sclerosis
- stress induced
- middle aged
- hiv infected
- quality improvement
- electronic health record
- interstitial lung disease
- smoking cessation