Rifampin-Induced Immune Hemolytic Anemia during Treatment of Pulmonary Tuberculosis in a Patient with Primary Sjogren's Syndrome
10.17945/kjbt.2019.30.3.246
- Author:
Jin Woo SOUK
1
;
Yang Ki KIM
;
Gae Eil JANG
;
Hyun Seok JEONG
;
Soo Taek UH
;
Ki Up KIM
;
So My KOO
;
Bo Young LEE
;
Hyunjin NOH
;
Woo Yong SHIN
;
Jeong Won SHIN
;
So Young JIN
Author Information
1. Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea. kyklung@schmc.ac.kr
- Publication Type:Case Report
- From:Korean Journal of Blood Transfusion
2019;30(3):246-252
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Drug-induced immune hemolytic anemia is a rare disease that occurs in 1 in 1 million individuals of the general population. Rifampin-induced immune hemolytic anemia is caused by drug-dependent antibodies and this can be treated without complication by drug cessation. Herein, we present a case of rifampin-induced immune hemolytic anemia in a patient with primary Sjogren's syndrome (pSS) which occurred during treatment of pulmonary tuberculosis. At admission, the patient's laboratory tests revealed hemolytic anemia and positive direct antiglobulin test result. Since the incidence of autoimmune hemolytic anemia (AIHA) in pSS is reported to be 3 percent, which is higher than that of the general population, differential diagnosis between AIHA and rifampin-induced immune hemolytic anemia was required for planning future anti-tuberculous treatment. We identified rifampin-dependent antibody by drug-induced immune complex test and diagnosed rifampin-induced immune hemolytic anemia. Based on this experience, if rifampin administration is considered in patients with systemic autoimmune disease such as pSS, which has a high incidence of AIHA, we suggest evaluating the presence and the cause of hemolytic anemia at baseline by testing serum lactate dehydrogenase, haptoglobin, and direct and indirect antiglobulin tests before drug administration to promptly identify the cause of hemolysis if hemolytic anemia develops.
