Immune haemolytic anaemia and renal failure induced by streptomycin

A case of acute immune haemolytic anaemia and renal failure induced by streptomycin, is reported. The clinical features are similar to those in a case previously reported in which no in vitro proof of antibodies was obtained. In this case, streptomycin-specific IgG antibodies, with both k and lambda light chains, could be demonstrated. The streptomycin bound strongly to the red cell membrane, apparently through chemical groups related to the M antigen and possibly also to the D antigen. Complement-fixation by the drug-specific IgG antibodies, after reaction with the streptomycin-coated red cells, could also be demonstrated. On the basis of these findings, our conclusion is that a complement-fixing hapten-cell mechanism was the main cause of the intravascular haemolytic episode suffered by the patient on exposure to streptomycin. This drug had been prescribed 15 years earlier for pulmonary tuberculosis and he had since injected himself with it whenever he felt "flu" symptoms, without harmful effects, until now.