Tahan S R, Diamond J R, Blank J M, Horan R F
Transfusion. 1985 Mar-Apr;25(2):124-7. doi: 10.1046/j.1537-2995.1985.25285169202.x.
Acute hemolysis as a reaction to rifampicin is extremely rare; case reports number less than 15. We recently evaluated a 65-year-old Cambodian refugee who self-regulated the use of rifampicin and isoniazid for pulmonary tuberculosis. Fifteen minutes after a single discontinuous oral dose, he developed flank pain, chills, rigors, vomiting, diarrhea, fever, and brown turbid urine. Laboratory tests at presentation showed acute intravascular hemolysis. Nonoliguric renal failure ensured, and he was transferred to our institution 2 days later. The patient was group A, Rh (D) positive, P1 negative with a cold autoantibody and cold anti-P1 alloantibody. The direct antiglobulin test was negative at the time of transfer. To evaluate the hemolysis, studies were done to test for rifampicin- or isoniazid-dependent antibodies. Rifampicin-dependent antibodies were detected in the antiglobulin phase with broad spectrum anti-human globulin, monospecific anti-gamma chain, and anti-complement antisera. Agglutination titers did not change after dithiothreitol reduction of the patient's serum. We conclude that this patient developed rifampicin-dependent IgG antibodies with complement-fixing capability. The presence of rifampicin-dependent antibodies should be suspected in a patient with hemolysis and/or renal failure taking rifampicin.
急性溶血作为对利福平的一种反应极为罕见；病例报告数量不足15例。我们最近评估了一名65岁的柬埔寨难民，他自行调整利福平和异烟肼用于治疗肺结核。单次间断口服给药15分钟后，他出现侧腹痛、寒战、发抖、呕吐、腹泻、发热以及茶色浑浊尿。就诊时的实验室检查显示急性血管内溶血。继而出现非少尿型肾衰竭，两天后他被转至我们机构。该患者为A组、Rh（D）阳性、P1阴性，有冷自身抗体和冷抗P1同种抗体。转院时直接抗球蛋白试验为阴性。为评估溶血情况，进行了检测利福平或异烟肼依赖性抗体的研究。在抗球蛋白阶段，使用广谱抗人球蛋白、单特异性抗γ链和抗补体抗血清检测到了利福平依赖性抗体。患者血清经二硫苏糖醇还原后，凝集效价未发生变化。我们得出结论，该患者产生了具有补体固定能力的利福平依赖性IgG抗体。对于正在服用利福平且出现溶血和/或肾衰竭的患者，应怀疑存在利福平依赖性抗体。
