Life-threatening cardiotoxicity with rifampicin, fucidic acid, and itraconazole

We describe in this case review of life-threatening cardiotoxicity and the need for ECMO treatment following rifampicin, fusidic acid, and itraconazole intake in a previously healthy 19-year-old rifampicin-naive man. The pronounced cardiotoxicity, despite a relatively low dose of rifampicin (9 g), was due to the concurrent intake of itraconazole and fusidic acid, which inhibit the elimination of rifampicin. This case illustrates the importance of considering drug interactions in unforeseen clinical scenarios and the possibility of bridging with ECMO to organ recovery in cases of life-threatening poisoning.