- 期刊
Life-threatening Thrombocytopenia after Rifampin Rechallenge in Tuberculosis-A Case Report and Literature Review
Rifampin重試驗誘發的致命性血小板減少症－一病例報告及文獻回顧
摘要
Rifampin是目前治療結核病最重要的藥物之一，由於殺菌作用較強，如與其他抗結核藥物合併使用能有效的縮短療程。此藥物一般耐受性良好，但嚴重副作用如肝炎，急性腎衰竭，休克，溶血性貧血，及血小板減少症也曾被報告過。Rifampin誘發的血小板減少症非常少見，傳統上此副作用被認為與rifampin間接性的投予有很大的關聯。因每日服用此藥物而導致血小板減少的案例則更為罕見。至今rifampin誘發血小板減少症的真正機轉還不是很明確，但一般認為由rifampin-抗rifampin抗體結合血小板所產生的免疫複合體是引起血小板破壞的最主要因素。此病例為一70歲女性，曾經有每日服用抗結核藥物的病史，但因對藥物耐受性不佳，四個月後即自行中斷治療。之後當肺結核復發時，重新給予每日一次低劑量的rifampin。病患於rifampin重試驗投予的四小時之內卻併發嚴重血小板減少症，猛暴性口腔黏膜出血及全身性的出血點。當此藥物停止使用後其出血頃向馬上得到緩解，而血小板數量也迅速回升到正常範圍。由於rifampin誘發的血小板減少症可引起致命性的危險，尤其在施予單次低劑量時，非常罕見。而由rifampin重試驗所引起的危機更有可能被低估。因此我們在此報告這一特殊病例並進一步藉由文獻的回顧來討論此藥物誘發血小板破壞的可能機轉。
並列摘要
In combination with other agents, rifampin is considered the key ingredient in the modern chemotherapy for Mycobacteria tuberculosis. However, infrequently, it may be associated with severe adverse reactions, such as hepatitis, acute renal failure, hemolytic anemia, and thrombocytopenia. Rifampin-induced thrombocytopenia is a rare event and traditionally has been considered to be related to intermittent treatment in higher doses. The incidence is extremely low if the treatment is given on a daily basis. The exact pathogenesis of rifampin-induced thrombocytopenia is still not fully understood, but an immune complex-mediated mechanism composed of rifampin and rifampin-dependent antibody binding to platelets has been postulated to explain this phenomenon. We report a 70-year-old woman who had been treated on a daily basis for pulmonary tuberculosis, but incompletely, and then developed life-threatening thrombocytopenia immediately after the reintroduction of rifampin. An explosive oral mucosal bleeding and generalized petechiae were noted 3 to 4 hours after the rifampicin rechallenge. Rifampin-induced thrombocytopenia is potentially life-threatening, though it is extremely rare, especially with a single, small dose of the drug. We herein present an unusual case and emphasize the importance of this easily overlooked rifampin rechallenge-related thrombocytopenia.
延伸閱讀
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