Acute renal failure caused by rifampicin re-exposure with 10-year of interval.

A 53-year-old woman was treated for recurrent pulmonary tuberculosis with reintroduction of rifampicin after a medication-free interval of 10 years. After taking the first dose, she developed severe hemolytic anemia and oliguric acute renal failure and required temporary hemodialysis. The fulminant clinical course was compatible with rifampicin-induced acute renal failure. The renal function of this patient completely recovered after discontinuation of rifampicin and temporary hemodialysis. Since renal biopsy and anti-rifampicin antibodies cannot offer a definite diagnosis of rifampicin-induced acute renal failure, we must emphasize the importance of a clinical diagnosis of rifampicin-induced acute renal failure and complete history taking. Re-exposure is a critical factor. In this case, the rifampicin-free interval was as long as 10 years. Because of the feasible prognosis, reintroduction of rifampicin for recurrent pulmonary tuberculosis should not be abandoned, but the infrequent and life-threatening side effects should be kept in mind.