title: Drug-induced immune haemolytic anaemia caused by levofloxacin.
abstract: Drug-induced immune haemolytic anaemia (DIIHA) is extremely rare. We herein report a case of life-threatening DIIHA due to levofloxacin. This is the second case reported in the literature. A 51-year-old woman presented with complaints of fatigue after 4-5 days of levofloxacin therapy for a lung infection. At presentation, she was found to have haemolysis with a positive Coombs test and IgG autoantibodies. Levofloxacin was identified as the probable culprit, using the Naranjo adverse drug reaction probability scale. Upon discontinuation of the drug and initiation of steroids, the patient's haematological parameters stabilised. Diagnosis of DIIHA is made through a history of intake of levofloxacin, clinical and laboratory features of haemolysis and a positive Coombs test. An autoantibody screen is most commonly positive for warm antibodies (IgG type). It is essential for clinicians to recognise this rare complication caused by a commonly prescribed medication, discontinue the offending drug and initiate treatment.
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, John H Stroger Jr Hospital of Cook County, 1969 W Ogden Ave, Chicago, Illinois 60612, USA. ssukhal@cookcountyhhs.org.
authors.forename: Shashvat
authors.initials: S
authors.lastname: Sukhal
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, John H Stroger Jr Hospital of Cook County, 1969 W Ogden Ave, Chicago, Illinois 60612, USA. ssukhal@cookcountyhhs.org.
authors.forename: Shweta
authors.initials: S
authors.lastname: Gupta
mesh_terms: D000743:Anemia, Hemolytic / Q000139:chemically induced*; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001323:Autoantibodies / Q000097:blood*; D005260:Female; D024841:Fluoroquinolones / Q000009:adverse effects; D006461:Hemolysis; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D064704:Levofloxacin / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D013256:Steroids / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D001323:Autoantibodies; D024841:Fluoroquinolones; D007074:Immunoglobulin G; D013256:Steroids; D064704:Levofloxacin