Department of Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.
Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada
BMJ Case Rep. 2023 Jan 3;16(1):e251119. doi: 10.1136/bcr-2022-251119.
We report the case of a previously healthy woman in her 60s who presented to the emergency department with acute confusion, vomiting and fever. She was recently diagnosed with a urinary tract infection as an outpatient and had completed the fifth day of a 7-day course of treatment with nitrofurantoin. We maintained a wide differential diagnosis including infectious, metabolic, autoimmune and medication-related causes. She developed an acute normocytic anaemia in hospital with a haemoglobin drop from 121 g/L to 89 g/L. Further investigation revealed evidence of haemolysis with an elevated bilirubin, lactate dehydrogenase, reticulocyte count and decreased haptoglobin. She was worked up for both inherited and acquired causes of haemolysis and found to have glucose-6-phosphate dehydrogenase deficiency. Her presentation was thought to be secondary to nitrofurantoin-induced haemolysis and she recovered completely with conservative management through intravenous fluids and discontinuation of nitrofurantoin.
我们报告了一例 60 多岁的既往健康女性，因急性意识混乱、呕吐和发热到急诊科就诊。她最近被诊断为尿路感染，并已完成了 7 天疗程的呋喃妥因治疗的第 5 天。我们保持广泛的鉴别诊断，包括感染性、代谢性、自身免疫性和与药物相关的原因。她在住院期间出现急性正细胞性贫血，血红蛋白从 121g/L 降至 89g/L。进一步的检查显示有溶血的证据，胆红素、乳酸脱氢酶、网织红细胞计数升高，结合珠蛋白减少。她被检查了遗传性和获得性溶血性贫血的原因，发现葡萄糖-6-磷酸脱氢酶缺乏。她的表现被认为是由呋喃妥因诱导的溶血引起的，通过静脉补液和停止使用呋喃妥因的保守治疗，她完全康复了。
