Serious side effects of rifampin on the course of WHO/MDT: a case report

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.