Recurrent symptomatic hypocalcemia during rifampicin therapy for brucellosis.

Abstract

Drug-associated hypocalcemia is rare, but may occur during routinely administered drugs. We reported a case of vertebral brucellosis, which developed two hypocalcemic episodes associated with hypokalemic alkalosis with two drug combinations including rifampicin. Possible underlying mechanisms of hypocalcemia were discussed. The patient had carpopedal spasm at both hypocalcemic presentations. Laboratory analysis revealed hypocalcemia, hypokalemia, alkalosis with hypercalciuria, and low-normal parathormone (PTH) at first and elevated PTH at the second admission. The patient improved with cessation of drugs and appropriate management of hypocalcemia and hypokalemia with calcium, vitamin D, magnesium, and potassium replacement. The underlying mechanism of hypocalcemia in this patient seemed to be due to tubular damage resulting with Bartter-like syndrome, which is well defined with aminogylcosides. But the recurrence of hypocalcemia with an aminoglycoside-free antibiotic combination including rifampicin suggests a possible role of rifampicin on hypocalcemia associated Bartter-like syndrome that has never been reported before.

• Authors: Ayse Nur Torun, Mehmet Ali Eren, Mehmet Demir, Tevfik Sabuncu
• Journal: Wiener klinische Wochenschrift (Wien Klin Wochenschr) Vol. 123 Issue 17-18 Pg. 566-8 (Sep 2011) ISSN: 1613-7671 [Electronic] Austria
• PMID: 21739210 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antibiotics, Antitubercular
• Calcitriol
• Calcium
• Rifampin
• Streptomycin

Topics

• Adult
• Antibiotics, Antitubercular (adverse effects, therapeutic use)
• Brucellosis (drug therapy)
• Calcitriol (administration & dosage)
• Calcium (administration & dosage, urine)
• Drug Therapy, Combination
• Female
• Humans
• Hypocalcemia (chemically induced, diagnosis, drug therapy)
• Recurrence
• Rifampin (adverse effects, therapeutic use)
• Spasm (chemically induced, urine)
• Spinal Diseases (drug therapy)
• Streptomycin (adverse effects, therapeutic use)
• Vitamin D Deficiency (complications, diagnosis, drug therapy)