Mattson K, Jänne J
Eur J Respir Dis. 1982 Jan;63(1):68-72.
Sixteen patients were given high-dose intermittent rifampicin treatment (900 mg twice weekly) in order to record side-effects of the flu-type. Three patients who experienced a febrile reaction were re-challenged under strict hospital supervision with a single dose (900 mg) of rifampicin. Two patients showed a distinct febrile response together with rapidly subsiding symptoms typical of the rifampicin-induced flu-syndrome, whereas the third patient's reaction was clinically different. During the challenge, the changes in a number of laboratory tests were indicative of a mild haemolytic reaction in the two patients with flu-syndrome. Plasma haemoglobin steeply increased within a few hours following the ingestion of the dose. This was associated with an acute increase in the total bilirubin and with a gradual decrease in the blood haemoglobin and haematocrit values. In further support of a drug-induced haemolysis was the findings that both patients showed a distinct reticulocyte response several days after the challenge. No such changes were seen in the third patient, whose reaction was later demonstrated to be related to isoniazid. The flu-syndrome thus may represent a first warning sign of intravasal haemolysis, which, if massive enough, eventually could lead to haemolytic crises and renal failure.
16名患者接受了高剂量间歇利福平治疗（每周两次，每次900毫克），以记录流感样副作用。3名出现发热反应的患者在严格的医院监督下再次接受单剂量（900毫克）利福平的挑战。两名患者出现明显的发热反应，同时伴有利福平诱导的流感综合征典型的迅速消退的症状，而第三名患者的反应在临床上有所不同。在挑战过程中，多项实验室检查的变化表明，两名患有流感综合征的患者出现了轻度溶血反应。服药后数小时内血浆血红蛋白急剧升高。这与总胆红素的急性升高以及血红蛋白和血细胞比容值的逐渐降低有关。进一步支持药物性溶血的是，两名患者在挑战后几天均出现明显的网织红细胞反应。第三名患者未出现此类变化，其反应后来被证明与异烟肼有关。因此，流感综合征可能是血管内溶血的第一个警示信号，如果溶血足够严重，最终可能导致溶血危机和肾衰竭。
