Drug-induced immune
hemolytic anemia is a
rare disease that occurs in 1 in 1 million individuals of the general
population.
Rifampin-induced immune
hemolytic anemia is caused by
drug-dependent
antibodies and this can be treated without complication by
drug cessation. Herein, we present a case of
rifampin-induced immune
hemolytic anemia in a
patient with primary
Sjogren's syndrome (pSS) which occurred during
treatment of
pulmonary tuberculosis. At admission, the
patient's
laboratory tests revealed
hemolytic anemia and positive
direct antiglobulin test result. Since the
incidence of
autoimmune hemolytic anemia (AIHA) in pSS is reported to be 3 percent, which is higher than that of the general
population,
differential diagnosis between AIHA and
rifampin-induced immune
hemolytic anemia was required for
planning future anti-tuberculous
treatment. We identified
rifampin-dependent antibody by
drug-induced
immune complex test and diagnosed
rifampin-induced immune
hemolytic anemia. Based on this experience, if
rifampin administration is considered in
patients with systemic
autoimmune disease such as pSS, which has a high
incidence of AIHA, we suggest evaluating the presence and the cause of
hemolytic anemia at baseline by testing
serum lactate dehydrogenase,
haptoglobin, and direct and
indirect antiglobulin tests before
drug administration to promptly identify the cause of
hemolysis if
hemolytic anemia develops.