Department for Internal Medicine, General Hospital "dr. Josip Benčević," Andrije Štampara 42, Slavonski Brod, Croatia.
Postgraduate Interdisciplinary Study of Molecular Bioscience, University of Josip Juraj Strossmayer, Cara Hardijana 8/A, Osijek, Croatia.
Medicine (Baltimore). 2021 Jul 2;100(26):e26234. doi: 10.1097/MD.0000000000026234.
Rifampicin is currently used to treat various bacterial infections, with the most significant application in the treatment of tuberculosis. Dose-independent side effects of the drug can lead to the development of various coagulation disorders, among which disseminated intravascular coagulation is the most dangerous. The mechanism of coagulopathy itself is multifactorial, but it is thought to be mediated by an immune response (formation of antigen-antibody complexes) and consequent damage to platelets and the vascular endothelium.
A 66-year-old woman, with numerous comorbidities including chronic renal failure, condition after implantation of a permanent pacemaker, and a positive blood culture for Staphylococcus aureus, presented with spontaneous bleeding in the muscle wall, and in the clinical picture of hemorrhagic shock.
Knowing the multifactorial mechanism of rifampicin-induced coagulopathy, possible factors were considered, such as infections, comorbidities, drug use and drug-drug interactions, pathological laboratory parameters, and coagulograms. Clinical presentation of abdominal pain and intra-abdominal mass, with laboratory verification of prolonged activated partial thromboplastin time and computed tomography-proven hematoma suspected of acute bleeding, redirects clinical suspicion of drug-induced coagulopathy.
By discontinuing rifapicin and administering vitamin K and fresh frozen plasma, normalization of laboratory coagulation parameters was achieved. Bleeding from the muscle wall required correction of acute anemia with red cell concentrates, surgical intervention, and additional antibiotic therapy for secondary infection of the operative wound.
At the end of 6 weeks of antibiotic (antistaphylococcal) therapy (due to the basic suspicion of possible infectious endocarditis), the normalization of inflammatory parameters occurred with a sterile control blood culture and a normal coagulogram.
Clinicians should be aware of the possible side effects of the administered drugs, especially taking into account the overall clinical picture of a patient, including comorbidities and possible drug interactions.
利福平目前用于治疗各种细菌感染，在治疗结核病方面的应用最为显著。药物的剂量依赖性副作用可导致各种凝血障碍的发生，其中弥散性血管内凝血最为危险。凝血障碍本身的发病机制是多因素的，但据认为是由免疫反应（抗原-抗体复合物的形成）和随之而来的血小板和血管内皮损伤介导的。
一名 66 岁女性，患有多种合并症，包括慢性肾衰竭、永久性起搏器植入后状态和金黄色葡萄球菌阳性血培养，出现自发性肌肉壁出血，并伴有失血性休克的临床表现。
鉴于利福平引起的凝血障碍的多因素发病机制，考虑了可能的因素，如感染、合并症、药物使用和药物相互作用、病理实验室参数和凝血谱。腹痛和腹部肿块的临床表现，以及延长的活化部分凝血活酶时间的实验室验证和计算机断层扫描证实的血肿提示急性出血，提示临床怀疑药物引起的凝血障碍。
通过停用利福平并给予维生素 K 和新鲜冷冻血浆，实现了实验室凝血参数的正常化。肌肉壁出血需要通过红细胞浓缩物纠正急性贫血，进行手术干预，并对手术伤口的继发感染进行额外的抗生素治疗。
在 6 周的抗生素（抗葡萄球菌）治疗结束时（由于基本怀疑可能发生感染性心内膜炎），炎症参数恢复正常，无菌控制血培养和正常凝血谱证实。
临床医生应意识到所使用药物的可能副作用，特别是要考虑到患者的整体临床情况，包括合并症和可能的药物相互作用。
