Nakahara Y, Katoh S, Yamada H, Kanetake Y, Terashima S, Tatsukawa H, Ida K, Shimazaki C, Nakagawa M
Department of Internal Medicine, Murakami Memorial Hospital, Asahi University, Gifu, Japan.
Nihon Jinzo Gakkai Shi. 1992 Nov;34(11):1233-6.
A case of acute immune hemolytic anemia associated with non-traumatic rhabdomyolysis (NTR) induced by streptomycin (SM) reinjection, which developed acute renal failure, has been reported. A 70-year-old female was admitted to our hospital because of sudden macroscopic hematuria after reinjection of 1g. SM. Laboratory findings on admission were as follows; hemoglobin and myoglobin were positive in urine. RBC 129 x 10(4)/microliters, Hb 4.9g/dl, Ht 11.1%, reticulocytes 52/1000, serum indirect billirubin 3.8g/dl, LDH 9, 230 WU, BUN 149mg/dl, Cr 7.9mg/dl, myoglobin 1, 400ng/ml and haptoglobin 10.6mg/dl. The drug lymphocyte stimulating test of SM was positive (215%). A direct antiglobulin test was also positive. An indirect antiglobulin test was negative, but became positive after incubation with SM. These observations made the diagnosis of SM-induced hemolytic anemia associated with NTR. On the second hospital day she developed anuria, and was put on hemodialysis treatment. Two months after the acute hemolytic episode and acute renal failure she recovered and is presently in good health without recurrence.
据报道，有一例因再次注射链霉素（SM）诱发非创伤性横纹肌溶解症（NTR）并导致急性肾衰竭的急性免疫性溶血性贫血病例。一名70岁女性在再次注射1g链霉素后因突然出现肉眼血尿入院。入院时实验室检查结果如下：尿中血红蛋白和肌红蛋白呈阳性。红细胞计数129×10⁴/微升，血红蛋白4.9g/dl，血细胞比容11.1%，网织红细胞52/1000，血清间接胆红素3.8g/dl，乳酸脱氢酶9230WU，血尿素氮149mg/dl，肌酐7.9mg/dl，肌红蛋白1400ng/ml，触珠蛋白10.6mg/dl。链霉素的药物淋巴细胞刺激试验呈阳性（215%）。直接抗球蛋白试验也呈阳性。间接抗球蛋白试验为阴性，但与链霉素孵育后变为阳性。这些检查结果确诊为链霉素诱发的溶血性贫血合并NTR。入院第二天她出现无尿，开始接受血液透析治疗。急性溶血发作和急性肾衰竭两个月后她康复，目前身体健康，未复发。
