Non hepatitis jaundice - adverse reaction to rifampicin
© Laza et al; licensee BioMed Central Ltd. 2014
Published: 15 October 2014
The hopes placed in the new treatment regimens for tuberculosis (TB), with the emergence of rifampicin were partially shaded by the side effects which were frequently recorded, able to impose temporary or definitive abandonment of this tuberculostatic.
The patient to be presented illustrates relapse of TB infection, in the context of significant comorbidities: chronic renal failure, uremic stage, in chronic hemodialysis program; primary hyperuricemia with urate nephropathy; stage II arterial hypertension with very high cardiovascular risk.
In the absence of clinical, definite biological and morphological criteria, the diagnosis of drug hepatopathy relies predominantly on causal relationship between the drug administration and the occurrence of the therapeutic accident. Non-hepatitis jaundice (liver tests normal) occurred after 2 weeks of daily tuberculosis treatment, suggesting the involvement of rifampicin in the conjugation of bilirubin and conjugated bilirubin excretion in the bile. The peculiarity of the case: In the patient presented, the fundamental mechanism behind the cholestatic syndrome consisted of: compromising the active transport of bilirubin through the liver cell, without being present the reflux of bile constituents (e.g., bile acids) in the circulation.
Adverse reactions to drugs due to their frequency and harmfulness have opened a new nosology chapter in modern medicine. Adverse effects of tuberculostatic drugs affect in a negative way both the management and the dynamics of TB infection.
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