Acute intravascular haemolysis associated with intravenous administration of meropenem in a sixty four year old man

We present the first reported case of severe intravascular haemolysis associated with the use of meropenem in a 64 year old man. The report highlights a further possible drug related cause of intravascular haemolysis. The patient, who had a background of dialysis dependent renal failure, epilepsy and learning difficulties, was admitted to the intensive care unit following laparotomy and large bowel resection. His background also included a reported childhood allergy to penicillin. Along with initial haemodynamic and ventilatory support he was treated with cefuroxime, metronidazole and gentamicin without incident. He went on to develop an abdominal collection, for which treatment included meropenem. Associated with the administration of meropenem was the development of severe intravascular haemolysis confirmed by laboratory analysis and microscopy, which resolved on cessation of meropenem therapy. We discuss the possible mechanisms involved in the development of drug induced haemolysis and suggest the most likely cause in this case.