Hemolytic anemia and pancytopenia induced by cefoxitin

A 77-year-old man received cefoxitin for the treatment of peritonitis. He developed hemolytic anemia and became clinically jaundiced. The patient was switched from cefoxitin to doxycycline. His total bilirubin decreased and his hematocrit increased. Several weeks later he developed septicemia. For an infiltration in the left lower lobe, he was treated with cefoxitin and gentamicin. The patient proceeded to develop a mild granulocytopenia and thrombocytopenia. Anemia was not seen because the patient was transfused several times. Bone marrow aspiration showed a mildly hypocellular marrow with a depression of all cell series, suggesting drug-induced bone marrow toxicity. Nine days after discontinuing cefoxitin, his blood elements had gone back to normal. This is the fourth case on file at Merck Sharp & Dohme of hemolytic anemia induced by cefoxitin. There have been several reports of hemolytic anemia or pancytopenia caused by cephalothin, but few, if any, citing the other cephalosporins, particularly cefoxitin. Clinicians should be made aware of the possibility of hematologic toxicities occurring with cefoxitin therapy. Patients should have their erythrocytes, leukocytes, and platelets monitored while on this drug.