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Rifampicin: not always an innocent drug
  1. Dafni Sveroni1,
  2. Aggelos Stefos1,
  3. Eirini I Rigopoulou1,2 and
  4. Georgios N Dalekos1,2
  1. 1 Department of Medicine and Research Laboratory of Internal Medicine, University Hospital of Larissa, Larissa, Greece
  2. 2 Institute of Internal Medicine and Hepatology, Larissa, Greece
  1. Correspondence to Professor Georgios N Dalekos, dalekos{at}


Rifampicin has been widely used due to its broad antibacterial spectrum. Acute haemolysis is a rarely encountered complication of rifampicin. A 58-year-old woman was admitted to our department because of high-grade fever with rigors, accompanied by abdominal and lumbar pain and laboratory evidence of acute haemolysis. She had been treated for brucellosis initially with doxycycline and streptomycin. Due to subsequent appearance of myositis, ciprofloxacin and rifampicin were added for treatment of localised brucellosis. After intravenous administration of rifampicin, the patient deteriorated significantly. After exclusion of other causes of haemolysis, autoimmune haemolytic anaemia related to rifampicin was established by strongly positive direct Coombs test. Drug withdrawal in conjunction with intravenous immune globulin and prednisolone resulted in resolution of haemolysis and no relapse in the ensuing 1-year period. Our case highlights the importance of recognising commonly administrative drugs as cause of haemolytic anaemia, that can often be life threatening.

  • haematology (incl blood transfusion)
  • haematology (drugs and medicines)
  • unwanted effects / adverse reactions

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  • Patient consent for publication Obtained.

  • Contributors GND and EIR were the principal treating physicians, had the original idea and designed the study. DS and AS collected and summarised the published literature and the data of the patient. DS, AS and EIR wrote the first draft of the manuscript. GND made the final critical revision of the manuscript for important intellectual content. All authors have seen and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.