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CORRESPONDENCE
Year : 2006  |  Volume : 51  |  Issue : 3  |  Page : 222
Rifampicin induced thrombocytopenia


Dept. of Dermatology, NRS Medical College, Kolkata, India

Correspondence Address:
Sudip Das
Dept. of Dermatology, NRS Medical College, Kolkata
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.27995

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How to cite this article:
Das S, Roy A, Maiti A. Rifampicin induced thrombocytopenia. Indian J Dermatol 2006;51:222

How to cite this URL:
Das S, Roy A, Maiti A. Rifampicin induced thrombocytopenia. Indian J Dermatol [serial online] 2006 [cited 2019 Nov 21];51:222. Available from: http://www.e-ijd.org/text.asp?2006/51/3/222/27995


In the era of fixed drug therapy for Hansen MB-MDT, WHO recommends once monthly supervised dosage of rifampicin, 100 mg of unsupervised dapsone and clofazimine 50 mg unsupervised daily and 300 mg of supervised dosage of clofazimine (on 1st day of the month) for 1 year period. Normally these are administered even by the health assistant (male and female) in remote rural set up.

Adverse reactions to dapsone without any significant side effects include 'Dapsone syndrome', a rare potentially fatal infectious mononucleosis like condition and three kinds of haemolytic anaemia, almost universally from a direct membrane defect, uncommonly from glucose 6-phosphate dehydrogenase enzyme deficiency and rarely as an idiosyncratic response.[1]

The common serious problem with rifampicin is hepatotoxicity. Red urine is alarming but banal. Once monthly dose is very rarely associated with severe haemolysis and renal failure.

Association of thrombocytopenia and rifampicin has not been well described. We report a 40-year-old fruit vendor with multiple anesthetic plaques who was put on WHO MB-MDT (multi drug therapy). After two months of MB-MDT he developed multiple ecchymoses with bleeding from gum. Investigation revealed haemoglobin was 9.2 gm/dl, TLC-10,500/cmm. platelet count 17,000/cmm with normal bleeding and clotting time. On stoppage of ALT, parameters normalized in 2 to 3 weeks time. After we stopped ALT, we stopped the dapsone and put him on rifampicin and clofazimine, but within 24 hours he developed malaise, fatigue with purpuric spots and ecchymoses all over body. Although other haematologic parameters were normal, platelet count become 10000/cmm. We immediately stopped rifampicin and put the patient on minocycline along with clofazimine and dapsone. Platelet count improved in 3 weeks time and ecchymoses and purpura resolved by 1 week time.

The patient has now completed full treatment for one year, two months and is released from treatment.

Thrombocytopenia to rifampicin is described rarely in literature[2] and this report is aimed to make us cautious of the fact that even a single monthly supervised dose of rifampicin can cause thrombocytopenia, probably because of idiosyncratic reaction.



 
   References Top

1.Dhople AM. Search for newer anti Leprosy drugs. Indian J Leprosy 2000;72:19.  Back to cited text no. 1  [PUBMED]    
2.Depasquale G. The Malta experience. Isoprodian-rifampicin combination treatment for leprosy. Lepr Rev 1986;46:29-37.  Back to cited text no. 2      



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