INTRODUCTION: The worldwide prevalence of adverse drug reactions (ADR) to anti-TB medication ranges from 8% to 85%. Major adverse reactions include hepatic, renal, and hematologic disorders of which, Rifampicin-induced thrombocytopenia is one of these rare complications. CASE: A 58-year-old Filipino male developed respiratory and gastrointestinal bleeding with a severe drop in platelet count after several days of anti-tuberculosis (anti-TB) medications. The patient had oral mucosal petechiae, blood-streaked sputum, and epistaxis. The symptoms progressed to the formation of small adherent clots beneath the tongue, gum bleeding, melena, massive epistaxis, and hemoptysis with continued intake of the anti-TB drugs. The patient had anemia, normal WBC and differential count, and thrombocytopenia of 3 x 10^3/uL, a drop from 235 x 10^3/uL five days prior. The bleeding resolved with the discontinuation of the drugs. A slow graded oral challenge to each of the drugs was done to identify the culprit medication. There was a recurrence of bleeding and a decrease in the platelet count after administration of rifampicin. The anti-TB medications were modified not to include rifampicin. The patient was discharged with no signs of bleeding and a normal complete blood count. CONCLUSION TB is a prevalent disease in our country, and its medications can cause adverse drug reactions. Rifampicin-induced thrombocytopenia is a rare and life-threatening condition that physicians must be aware of and able to recognize promptly and treat properly to prevent recurrence of similar cases in the future. The patient should be forewarned not to take rifampicin and any fixed-dose combination drugs containing rifampicin.
Rifampin ; Thrombocytopenia ; Blood Platelets ; Tuberculosis