出血および血小板減少をきたしたリファンピシン使用の1例

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A case, who developed acute thrombocytopenia with gingival bleeding following an intermittent administration of high dose of rifampicin is reported.<BR>The patient, a 53-year-old Japanese woman, was diagnosed in 1940 as pulmonary tuberculosis. Since 1956 she had received therapy with various combinations of streptomycin, sodium paraaminosalicylate, isoniazid, kanamycin, viomycin, ethionamide and ethambutol without any toxicity and hypersensitivity. Acid fast bacilli had been found on direct examination of her sputum, and cultures for mycobacterium tuberculosis had been positive.<BR>From April 1971 the regimen was changed to ethambutol 1.0g plus isoniazid 500mg daily plus kanamycin 2.0g plus rifampicin 900mg twice weekly. In August 1971, after four months of the therapy, she complained of gingival bleeding and spots of skin.<BR>The numerous small petechiae were generally seen on skin. There were no hepato splenomegaly and no other relevant physical findings. The platelets were 60, 000/cu. mm, and total white cell count 6, 100/cu. mm, and red cell morphology was normal. Rifampicin and other drugs were discontinued. Two days after the discontinuation of the drugs, the purpuric eruptions faded and after two weeks the platelet count returned to normal.<BR>After four weeks, 450mg of rifampicin was readministered, and three hours later the platelet count dropped from 260, 000/cu. mm to 4, 100/cu. mm and at 27 hours later to 1, 800/cu. mm. At fourth day, the platelet count began to rise, and reached to 200, 000/cu. mm at five days after the readministration. After three months she became well with platelets of 360, 000/cu. mm.
日本結核病学会の論文

出血および血小板減少をきたしたリファンピシン使用の1例

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