Ceftriaxone-induced hemolytic anemia and hepatitis in an adolescent with hemoglobin SC disease.
OBJECTIVE
To describe a case of a ceftriaxone-induced hemolytic anemia and hepatitis leading to multiple organ failure and death in an adolescent with hemoglobin SC disease and to review the previous cases of this rare and potentially fatal disorder in children.


METHODS
Case report and literature review.


METHODS
Intensive care unit.


METHODS
Adolescent with hemoglobin SC.


METHODS
Emergency treatment.


RESULTS
After 4 days of ceftriaxone therapy, the adolescent experienced an acute hemolytic reaction (hemoglobin decreased to 5 g/dL with hemoglobinuria) and severe hepatitis (all enzymes increasing dramatically including aminoaspartate transferase >20,000 IU/L). Renal failure and ultimately multiple organ failure ensued, and the patient died on hospital day 19. Direct antiglobulin tests on red cells obtained from the patient on hospital day 2 showed microscopic agglutination with polyspecific and anticomplement (C3) antiglobulin reagents. Plasma samples showed macroscopic agglutination reactions when incubated in the presence of ceftriaxone, many days after cessation of ceftriaxone, indicating the continued presence of ceftriaxone-dependent antibodies.


CONCLUSIONS
Drug reactions leading to hemolysis are relatively uncommon, and a total of ten cases of ceftriaxone-induced hemolytic anemia have been reported in children. The present case describes an adolescent who ultimately died on hospital day 19 from multiple organ failure, although the presentation of this case seems atypical in several respects. Children with clinical syndromes that place them at risk for hemolysis and children who frequently require broad spectrum antibiotics present unique diagnostic challenges, and the possibility that hemolytic syndromes may be due to ceftriaxone must be considered.
Bell
Michael J
MJ
Division of Critical Care Medicine, Children's National Medical Center and The George Washington University School of Medicine, Washington, DC, USA.
Stockwell
David C
DC
Luban
Naomi L C
NL
Shirey
R Sue
RS
Shaak
Lorraine
L
Ness
Paul M
PM
Wong
Edward C C
EC
D000293:Adolescent; D000743:Anemia, Hemolytic / Q000139:chemically induced*; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D002443:Ceftriaxone / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D006450:Hemoglobin SC Disease / Q000150:complications*; D006801:Humans; D009102:Multiple Organ Failure / Q000139:chemically induced
D000900:Anti-Bacterial Agents; D002443:Ceftriaxone