Rifampicin Hypersensitivity in a Pediatric Case of Brucellosis: A Case Report

Abstract

Background: Brucellosis is a zoonotic infection that remains endemic in many regions and represents a significant public health problem. Clinical manifestations in children are often nonspecific, and musculoskeletal involvement is among the most frequent focal complications. Combination therapy with rifampicin and doxycycline, or rifampicin and trimethoprim–sulfamethoxazole in pediatric patients, is recommended as first-line treatment. However, drug hypersensitivity may complicate management and limit therapeutic options.Case Presentation: We report the case of a previously healthy 10-year-old boy who presented with fever and left knee pain following close contact with sheep. Brucellosis was confirmed by positive standard agglutination and Coombs tests. He was initially treated with doxycycline and rifampicin. After two weeks, the patient developed fever, vomiting, pruritus, conjunctivitis, eosinophilia, and elevated transaminases. Symptoms resolved upon discontinuation of rifampicin and recurred after re-initiation of anti-brucellosis therapy, strongly suggesting rifampicin hypersensitivity. Pediatric allergy consultation confirmed the suspicion, and rifampicin was permanently withdrawn. The patient was successfully treated with doxycycline and gentamicin (14 days of gentamicin, doxycycline for 6 weeks), leading to full clinical and laboratory recovery.Conclusion: Rifampicin and doxycycline are essential first-line agents in the treatment of pediatric brucellosis in children older than 8 years, but hypersensitivity reactions, though rare, may mimic disease relapse or complications. To our knowledge, this is the first reported pediatric case of rifampicin hypersensitivity in brucellosis. Awareness of this possibility is crucial for timely recognition and appropriate management. Alternative regimens, such as doxycycline combined with aminoglycosides, can provide effective treatment in children unable to tolerate rifampicin.