Chan Gomez Janet, Saleem Tabinda, Snyder Samantha, Joseph Maria, Kanderi Tejaswi
Internal Medicine, University of Pittsburgh Medical Center (UPMC) Pinnacle, Harrisburg, USA.
Cureus. 2020 Jun 17;12(6):e8666. doi: 10.7759/cureus.8666.
Drug-induced immune hemolytic anemia (DIIHA) is a rare cause of anemia. It is often difficult to distinguish from other causes of hemolytic anemia, thereby delaying diagnosis and treatment. Antibiotics, including penicillins and cephalosporins, are the drugs most often implicated in the development of DIIHA. Discontinuation of the offending agent is often sufficient for treatment. Here, we review the case of a 25-year-old Caucasian female who presented with jaundice and generalized weakness in the setting of outpatient treatment with amoxicillin-clavulanate due to sinus infection. Laboratory testing revealed transaminitis and hemolytic anemia. Direct antiglobulin test (DAT) revealed negative IgG and positive anti-C3. Cold agglutinin titer and Donath-Landsteiner test were negative. The patient was diagnosed with DIIHA most likely due to amoxicillin. She improved with drug cessation and a short course of glucocorticoids. Mechanism of DIIHA, workup, and management are subsequently reviewed.
药物性免疫性溶血性贫血（DIIHA）是一种罕见的贫血病因。它常常难以与其他溶血性贫血病因相区分，从而延误诊断和治疗。包括青霉素和头孢菌素在内的抗生素是最常与DIIHA发生相关的药物。停用致病药物通常足以进行治疗。在此，我们回顾了一例25岁白种女性的病例，该患者因鼻窦感染在门诊接受阿莫西林 - 克拉维酸治疗时出现黄疸和全身无力。实验室检查显示转氨酶升高和溶血性贫血。直接抗球蛋白试验（DAT）显示IgG阴性和抗C3阳性。冷凝集素滴度和唐奈 - 兰德斯泰纳试验均为阴性。该患者最有可能因阿莫西林被诊断为DIIHA。她通过停药和短期使用糖皮质激素后病情好转。随后对DIIHA的机制、检查和管理进行了回顾。
