Rifampicin - Induced Fever

Rifampicin is a commonly used first-line antitubercular drug well known for its safety and efficacy and is generally well tolerated. Flu-like syndrome is the main cause of fever in rifampicin treated patients. High grade fever without accompanying features of hypersensitivity or flu is an extremely rare occurance. Our patient presented with pyrexia of unknown origin and diagnostic work-up revealed sufficient evidence of tuberculosis. Consequently, she was started on first –line antituberculous treatment (ATT) following which fever aggravated. Repeat diagnostic work-up did not reveal any other clue to the cause of fever. To our surprise, the fever subsided promptly on stopping ATT, suggesting it to be drug-induced. Sequential reintroduction of the drugs revealed rifampicin to be the culprit. Thereafter, rifampicin was withdrawn permanently from the therapy and patient was put on modified ATT, following which, patient became apyrexial and significant clinical improvement was noticed.