A case of cephalosporin-induced autoimmune hemolytic anemia

Abstract

Drug-induced autoimmune hemolytic anemia is a quite rare state in childhood. Currently, most of the reported cases of drug-induced hemolytic anemia are those caused by the second and third generation cephalosporins. In this paper, an infant who developed autoimmune hemolytic anemia after cephalosporin treatment is reported. An eight month-old patient first received intramuscular ceftriaxone which followed by intravenous cefotaxime and oral cefixime for treatment of pyelonephritis. Laboratory tests performed during the investigation of the cause of anemia revealed: Direct Coombs test +2, reticulocyte: 2%, LDH 784 IU/L, AST 288 IU/L and ALT 178 IU/L. Anemia was assumed to be induced by cephalosporins and the cephalosporin treatment was withdrawn. On the third week of the follow-up, Coombs test became negative and the next week, hemoglobin level was increased to 13.1 g/dl without any intervention.