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Ceftriaxone-induced hemolysis in a child with Lyme arthritis: a case for antimicrobial stewardship

Sarah R Boggs1, Kenji M Cunnion, Reem H Raafat

  • 1Division of Infectious Diseases, Children's Hospital of The King's Daughters and Eastern Virginia Medical School, Norfolk, VA 23508, USA. boggssr@chkd.org

Pediatrics
|October 5, 2011
PubMed

Insights

Antimicrobial stewardship is crucial. A young patient developed severe complications, including autoimmune hemolytic anemia and renal failure, after intravenous ceftriaxone treatment for Lyme arthritis, emphasizing careful drug selection.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Nephrology

Background:

  • The Infectious Diseases Society of America (IDSA) 2006 guidelines recommended oral doxycycline for Lyme arthritis.
  • Lyme arthritis is a common manifestation of late-stage Lyme disease.

Observation:

  • A pediatric patient received intravenous ceftriaxone for Lyme arthritis.
  • The patient subsequently developed drug-induced autoimmune hemolytic anemia (AIHA).
  • The patient also experienced acute renal failure.

Findings:

  • Intravenous ceftriaxone, though effective for Lyme disease, can precipitate rare but severe adverse drug events.
  • AIHA and renal failure represent significant, potentially life-threatening sequelae.
  • This case underscores the critical need for judicious antibiotic use.

Implications:

  • Highlights the importance of antimicrobial stewardship in pediatric infectious disease management.
  • Suggests a need for heightened awareness of potential severe adverse events with broad-spectrum antibiotics.
  • Emphasizes the balance between effective treatment and minimizing iatrogenic complications.

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