Levofloxacin-induced autoimmune hemolytic anemia.
OBJECTIVE
To report a case of autoimmune hemolytic anemia (AIHA) secondary to levofloxacin.


METHODS
An 82-year-old white man was treated with levofloxacin 500 mg/d for cellulitis. Three days following completion of levofloxacin therapy, the patient presented to the emergency department with severe jaundice, dizziness, and loss of vision. He received packed red blood cells (PRBCs) and was discharged home. Two days later at the follow-up visit, he was diagnosed with AIHA secondary to levofloxacin. The patient was hospitalized and treated with a tapering dose of prednisone and additional PRBC infusion. He was discharged from the hospital in stable condition after 3 days. Repeated hematologic laboratory studies following discharge demonstrated that the hemolytic anemia had resolved.


CONCLUSIONS
Hemolytic anemia due to levofloxacin is an extremely rare, but potentially fatal, adverse drug event. An objective causality assessment revealed that the adverse reaction was probable. To our knowledge, this is the first published case of levofloxacin-induced AIHA. However, there are published case reports of hemolytic anemia with other fluoroquinolones including ciprofloxacin (n = 12) and temafloxacin (n = 95). Temafloxacin was withdrawn from the market in 1992 due to this adverse effect. The mechanism by which levofloxacin triggers hemolytic anemia is unknown. We believe that an immune-mediated reaction is most likely.


CONCLUSIONS
Levofloxacin-induced AIHA is a rare but serious complication of therapy. Immediate discontinuation of the offending medication and treatment of the hemolytic anemia are essential. Until more information is available, levofloxacin should not be prescribed for patients with previous reactions to any fluoroquinolone.
Oh
Young R
YR
Department of Clinical Pharmacy Services, David Grant USAF Medical Center, Travis Air Force Base, CA, USA. young.oh@60mdg.travis.af.mil
Carr-Lopez
Sian M
SM
Probasco
James M
JM
Crawley
Peter G
PG
D000368:Aged; D000369:Aged, 80 and over; D000744:Anemia, Hemolytic, Autoimmune / Q000139:chemically induced* / Q000188:drug therapy / Q000378:metabolism; D000890:Anti-Infective Agents / Q000009:adverse effects*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D004244:Dizziness / Q000139:chemically induced; D005260:Female; D006801:Humans; D007565:Jaundice / Q000139:chemically induced; D064704:Levofloxacin; D015242:Ofloxacin / Q000009:adverse effects*; D011241:Prednisone / Q000627:therapeutic use; D014786:Vision Disorders / Q000139:chemically induced
D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents; D064704:Levofloxacin; D015242:Ofloxacin; D011241:Prednisone