Esteves Alexandra, Teixeira da Silva Francisco, Carvalho José, Carvoeiro Ana, Felgueiras Paula
Internal Medicine, Unidade Local de Saúde do Alto Minho, Viana do Castelo, PRT.
Cureus. 2021 Jan 25;13(1):e12903. doi: 10.7759/cureus.12903.
Non-steroidal anti-inflammatory drugs are widely used for pain management. Most frequently, adverse reactions affect the gastrointestinal tract and hematological side effects usually relate to the gastrointestinal manifestations. Drug-induced immune hemolytic anemia is a rare and frequently underdiagnosed complication that is associated with poor outcomes including organ failure and even death. A 76-year-old female patient was treated with intramuscular diclofenac, thiocolchicoside, and diazepam for low back pain. Five days following diclofenac exposure, the patient was admitted to the Emergency Department with complaints of asthenia, nausea, vomiting, and diarrhea. Hemolysis and a positive direct antiglobulin test were detected on laboratory testing. Further causes of hemolytic anemia were excluded and a diagnosis of diclofenac-induced immune hemolytic anemia was established. Glucocorticoid therapy initiated on admission and drug eviction led to complete recovery. Long-term follow-up showed no recurrence of anemia. Here, we present the unusual case of a successful recovery of a 76-year-old patient with diclofenac-induced immune hemolytic anemia, a rare but immediate life-threatening condition of a frequently used drug in clinical practice.
非甾体抗炎药被广泛用于疼痛管理。最常见的是，不良反应影响胃肠道，血液学副作用通常与胃肠道表现有关。药物性免疫性溶血性贫血是一种罕见且常被漏诊的并发症，与包括器官衰竭甚至死亡在内的不良后果相关。一名76岁女性患者因腰痛接受了双氯芬酸、硫代秋水仙碱和地西泮的肌肉注射治疗。在接触双氯芬酸五天后，患者因乏力、恶心、呕吐和腹泻被收入急诊科。实验室检查发现溶血和直接抗球蛋白试验阳性。排除了溶血性贫血的其他病因，确诊为双氯芬酸诱导的免疫性溶血性贫血。入院时开始使用糖皮质激素治疗并停用药物后患者完全康复。长期随访显示贫血未复发。在此，我们报告一例76岁双氯芬酸诱导的免疫性溶血性贫血患者成功康复的罕见病例，这是临床实践中常用药物引发的一种罕见但危及生命的疾病。
