Drug Reaction to Rifampisin Confirmed

by Bio Resonance, Challenge,

and Dichallenge Methode :
A Case Report
Utami Ningsih1, Suswardana2
1Medicine Student at Trisakti University

SMF Dermatology and Venereology

RSAL dr. Mintohardjo
 Introduction

Appreciably harmful or unpleasant reaction,

resulting from an intervention related to the use of
a medicinal product, which predicts hazard from
future administration and warrants prevention or
specific treatment, or alteration of the dosage
regimen, or withdrawal of the product

1
Edwards IR, Aronson JK. Adverse drug reactions: definitions, diagnosis, and management
Lancet. 2000 Oct 7;356(9237):1255-9.
 Anti-tuberculosis drugs frequently result in cutaneous
adverse reaction such as skin itching.

Rifampicin is a medicine which is used in certain types

of bacterial infections and tuberculosis

1. Anonymous. Rifampicin. In : http://www.nhs.uk/medicine-

guides/pages/MedicineOverview.aspx?condition=tuberculosis&medicine=rifampicin&preparation=Rifampicin%20150mg
%20capsules. Accessed on February 18th 2015.
2 2. Sehgal VN, Srivastava G. Fixed Drug Eruption (FDE) : changing Scenario of Incriminating Drugs.Int J Dermatol. 2006
Aug;45(8):897-908.Lehloenya RJ, Dheda K. Cutaneous adverse drug reactions to anti-tuberculosis drugs: state of the art
and into the future. Expert rev Anti Infect Ther. 2012 Apr; 10 (4): 475-86.
 Case
A 49 years old man came to the clinic for
complained about the itching over his body
from 1 month ago
This complaint was felt after patients taking
rifampicin for extra pulmonary tuberculosis

3
 A 49 years old man came to the clinic for complained about
the itching over his body from 1 month ago

Anamnesis
- complained of headache and sore throat and took
( 3 month decolgen and methylprednisolone to resolve the
complains
ago)
- complained of a lump in the anal region and bloody
stool that is mistaken for Hemorrhoids

( 2 month surgical biopsy on the location of the complaint and

ago) obtained the diagnosis of extra pulmonary tuberculosis
and received INH and ethambutol therapy

(January -Patient received therapy INH , rifampicin , and ethambutol

- One of the drug dose ( INH / ethambutol ) was increase
4 2nd, 2015) from 400mg to 600mg
 29 January 2015 Patient began to complained of itching that occured
throughout the day and make the patient can not sleep

Patient came to our clinic for treatment and tests bio

resonance which generated the suspicion of allergy
rifampicin

30 January 2015 patient asked to consume etambutol 1 tablet

31 January2015 Etambutol no complaints of itching

Patient asked to consume Pirazinamid
1 tablet

1 February 2015 Pirazinamid no complaints of itching

Patient asked to consume INH 1 tablet

2 February 2015 INH no complaints of itching

5
Patient asked to consume Rifampicin tablet
 Discussion

First- and second-line anti-tuberculosis drugs are associated with a diverse presentation of
cutaneous adverse drug reactions (CADR), ranging from mild to life threatening. An individual
drug can cause multiple types of CADR, and a specific type of CADR can be due to any anti-
tuberculosis drug, which can make the management of tuberculosis (TB) following CADR
challenging4

3. Sehgal VN, Srivastava G. Fixed Drug Eruption (FDE) : changing Scenario of Incriminating Drugs.Int J
7 Dermatol. 2006 Aug;45(8):897-908.
4. Lehloenya RJ, Dheda K. Cutaneous adverse drug reactions to anti-tuberculosis drugs: state of the art and
into the future. Expert rev Anti Infect Ther. 2012 Apr; 10 (4): 475-86.
 Rifampicin is a semi-synthetic derivative of rifamycin, a natural product, which
was isolated in 1957 from a strain of the fungus Amycolatopsis
rifamycinica (originally Streptomyces mediterranei) obtained from a soil
sample from the French Riviera, which used in first line Anti-Tuberculosis
Drugs

The most important and effective therapeutic measure in managing drug

hypersensitivity reactions is the discontinuation of the offending medication, if
possible. Alternative medications with unrelated chemical structures should be
substituted when available.

5. Dougan A. Tuberculosis and a focus on rifampicin. In : http://www.pharmaceutical-

journal.com/learning/learning-article/tuberculosis-and-a-focus-on-rifampicin/11135743.article.
8 Accessed on February 18th 2015.
6. Riedl MA1, Casillas AM. Adverse Drug Reactions: Types and Treatment Options. Am Fam
Physician. 2003 Nov 1;68(9):1781-90.
 Conclusion

Rifampicin may cause itching. Comphrehensive

history taking is very important. Bio resonance,
challenge, and dechallenge method is essential
to early identify the etiology of itching.

9
Thank You