title: A case of immune hemolytic anemia induced by ceftizoxime and cefobactam (sulbactam/cefoperazone).
abstract: Simultaneous drug-induced immune hemolytic anemia (DIIHA) caused by multiple drugs is rare. We report a case of a patient who developed DIIHA caused by 2 drugs. The patient's serum exhibited agglutination of ceftizoxime- or sulbactam-coated red blood cells (RBCs; via a drug-adsorption mechanism) and of uncoated RBCs in the presence of sulbactam (via an immune-complex mechanism). Although ceftizoxime is known to exhibit a positive reaction by an immune-complex method with or without reactivity with drug-coated RBCs, this patient's antibodies were reactive only against drug-coated RBCs. On the other hand, sulbactam, which is known to cause hemolytic anemia by nonimmunologic protein adsorption, exhibited positive reactions in tests with both drug-coated RBCs and in the presence of sulbactam. This is the first report of DIIHA due to a sulbactam-cefoperazone combination and the fourth report of DIIHA due to ceftizoxime. Owing to the patient's complicated laboratory results, DIIHA was suspected only at a late stage. We propose that for the prompt diagnosis of DIIHA, tests for all possible causative drugs should be conducted by 2 methods.
authors.affiliation: Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Eun Jung
authors.initials: EJ
authors.lastname: Baek
authors.forename: Sungsil
authors.initials: S
authors.lastname: Lee
authors.forename: Sinyoung
authors.initials: S
authors.lastname: Kim
authors.forename: Hyun Kyung
authors.initials: HK
authors.lastname: Choi
authors.forename: Hyun Ok
authors.initials: HO
authors.lastname: Kim
mesh_terms: D000743:Anemia, Hemolytic / Q000139:chemically induced / Q000175:diagnosis* / Q000276:immunology; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D002438:Cefoperazone / Q000009:adverse effects*; D015296:Ceftizoxime / Q000009:adverse effects*; D004912:Erythrocytes / Q000737:chemistry / Q000378:metabolism; D005260:Female; D006801:Humans; D008875:Middle Aged; D013407:Sulbactam / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D002438:Cefoperazone; D015296:Ceftizoxime; D013407:Sulbactam