Harlow Christopher Francis, Meghji Jamilah, Martin Laura, Harris Timothy, Kon Onn Min
Department of Chest and Allergy, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
Department of Chest and Allergy, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
BMJ Case Rep. 2020 Feb 2;13(1):e232117. doi: 10.1136/bcr-2019-232117.
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.
我们报告了一例年轻的亚洲女性类风湿关节炎患者，该患者在使用生物制剂治疗前接受了潜伏性结核感染（LTBI）治疗，并在再次接触利福平后出现了顽固性低血压休克。我们讨论了利福平诱导休克的流行病学、病理生理学和管理，得出结论：临床医生应意识到这种罕见但潜在的不良反应，并注意在再次接触或较长给药间隔方案期间，利福平的不良反应更为频繁。目前缺乏针对此类反应后脱敏治疗的证据，因此不建议采用这种方法。我们建议，在发生反应后需要进行LTBI治疗时，开具免疫抑制药物的专科与结核病治疗团队之间应密切合作，并让患者参与讨论治疗方案的风险和益处。
