Ceftriaxone-Induced Hemolytic Anemia: A Rare and Fatal Reaction

Area of Science:

• Pharmacology
• Hematology
• Internal Medicine

Background:

• Ceftriaxone is a widely used cephalosporin antibiotic for broad-spectrum bacterial infections.
• Hemolytic anemia is a rare but serious adverse reaction associated with certain medications.
• Osteomyelitis requires appropriate antibiotic therapy, often involving de-escalation strategies.

Observation:

• A 65-year-old female patient with osteomyelitis was treated with antibiotics.
• The patient was initially on cefepime and subsequently de-escalated to ceftriaxone.
• Within 48 hours of ceftriaxone administration, the patient developed acute symptoms.

Findings:

• The patient presented with truncal pain, nausea, vomiting, and a rapid decrease in hemoglobin levels.
• Laboratory findings indicated drug-induced hemolytic anemia.
• The patient also developed disseminated intravascular coagulation and multi-system organ failure.

Implications:

• This case highlights ceftriaxone as a potential rare cause of severe hemolytic anemia.
• Clinicians must maintain a high index of suspicion for drug-induced hemolytic anemia with ceftriaxone.
• Prompt recognition and management are critical to prevent severe complications and improve patient outcomes.