Rifampicin (RFP) 0.45 g daily was prescribed to a 54 years old male patient with pulmonarytuberculosis in Jan. 1980. He had taken RFP for one year in 1975 and had experienced slight fever, which had disappeared after the cessation of RFP.
On the tenth day after the re-administration of RFP, the patient suddenly developed chills, severelumbago, hypotension and became anuric. Blood chemistry showed severe hemolytic anemia andacute renal failure, and the serum was red wine colored. All the medications (INH, RFP, EB and1314TH) were stopped and peritoneal dialysis (PD) was begun. After two weeks on PD, the urinevolume was restored and blood chemistry results became almost normal. The direct antiglobulintest was positive at the onset of the crisis but became negative 13 days later. Indirect antiglobulintest was negative throughout the course. RFP was suspected to be the causing agent and the followingin vitro tests were undertaken.
(i) On the 40th day after the crisis, his blood was taken, heparinized and was incubated withor without RFP. The direct antiglobulin test of this blood was positive only under the presence ofRFP. Blood from a control subject did not show positive results under the presence of RFP.
(ii) The indirect antiglobulin test using his serum was performed with or without RFP. Thistest yielded positive results only under the presence of RFP. Sera from control subjects receiving RFPwithout adverse reactions showed negative results on both with and without RFP.
From these results RFP was regarded to be responsible for this hemolytic crisis. The usefulnessof using the direct antiglobulin test on whole blood-drug mixture (i) as a simple screening test is discussed.
