Ceftriaxone-induced immune hemolytic anemia: a case report

Area of Science:

• Hematology
• Pharmacology
• Pediatrics

Background:

• Drug-induced immune hemolytic anemia (DIIHA) is a rare but serious adverse drug reaction.
• Antibiotics are frequently implicated in DIIHA, often leading to misdiagnosis and severe complications.
• Ceftriaxone is identified as a common causative agent for DIIHA.

Observation:

• A 5-year-old patient presented with symptoms of DIIHA after cefazoxime and azithromycin treatment.
• Following initial recovery, the patient developed severe anemia and hemolysis after receiving ceftriaxone.
• Clinical presentation included rash, hemoglobinuria, jaundice, and abdominal pain, with a positive Coombs' test.

Findings:

• Ceftriaxone was identified as the causative agent for DIIHA in this pediatric case.
• Prompt discontinuation of ceftriaxone and supportive care, including transfusions and plasma exchange, led to patient recovery.
• The case underscores the importance of considering ceftriaxone in the differential diagnosis of DIIHA.

Implications:

• Early recognition and withdrawal of the offending antibiotic are crucial for managing DIIHA.
• Aggressive supportive care, including blood transfusions and plasma exchange, can be life-saving.
• Increased awareness of ceftriaxone-induced DIIHA is needed to prevent misdiagnosis and improve patient outcomes.