A male born in 1935 was diagnosed as having lepromatous leprosy when he was
17 years old. In addition to dapsone (DDS) monotherapy, he had been treate
d with rifampin (RMP) fur 2 terms: first with 450 mg a day for 2 years when
he was 39 years old; second with 150 mg a day for 2 months after a 1-year
interval from the first regimen. During these entire courses with RMP, no c
omplication was noted.
When he was 64 years old in 1999, a diagnosis of relapsed borderline tuberc
uloid (BT) leprosy was made, and he was started on the multibacillary (MB)
regimen of the World Health Organization multidrug therapy (WHO/MDT). After
the third dose of monthly RMP, he developed a flu-like syndrome and went i
nto shock. A few hours later, intravascular hemolysis occurred followed by
acute renal failure. lie was placed on hemodialysis for 7 series and recove
red almost completely about 2 months later. The immune complexes with anti-
RMP antibody followed by complement binding may have accounted for these sy
mptoms.
Twenty-four reported cases of leprosy who had developed side effects of RMP
under an intermittent regimen were analyzed; 9 of the cases had had prior
treatment with RMP but 15 had not. Adverse effects were more likely to occu
r in MB cases and were more frequent during the first 6 doses of intermitte
nt regimens. The cases with prior treatment with RMP had had a higher incid
ence of serious complications such as marked hypotension, hemolysis and acu
te renal failure. However, many exceptions were also found, and we could no
t verify any fully dependable factor(s) to predict the side effects of RMP.
More field investigation is desirable, and monthly administration of RMP m
ust be conducted under direct observation through the course of WHO/MDT.