Case Report: rapid exacerbation of autoimmune hemolysis and severe immune - mediated thrombocytopenia induced by piperacillin - tazobactam.

BACKGROUND: Piperacillin-tazobactam (PIP-TAZ) is characterized by its broad antimicrobial spectrum, strong antibacterial activity, and low toxicity, playing a vital role in the treatment of infectious diseases. However, with its widespread use, reports of drug-induced immune hemolytic anemia (DIIHA) and drug-induced thrombocytopenia (DITP) have begun to emerge. Due to the relatively rare clinical incidence of these conditions, clinicians often have an inadequate understanding and lack corresponding management experience. Fortunately, we encountered a case in clinical practice that we quickly identified and successfully treated.

CASE PRESENTATION: An 83-year-old Chinese female patient was treated with PIP-TAZ for pneumonia. On the fourth day of treatment, she exhibited pronounced symptoms of jaundice, accompanied by elevated total bilirubin levels, severe hemolytic anemia and thrombocytopenia. Upon investigating the underlying cause, we found that the concentration of PIP-TAZ in her blood was significantly higher than the normal therapeutic range, and PIP-TAZ-dependent antibodies were detected in her serum. We ultimately diagnosed her with DIIHA combined with DITP. Following prompt recognition and management, the patient made a full recovery and was subsequently discharged.

CONCLUSION: This article presents a case of acute immune hemolytic anemia and immune thrombocytopenia induced by PIP-TAZ. Effective treatment strategies include the prompt identification and discontinuation of the offending drug, blood transfusions, intravenous immunoglobulin (IVIG), corticosteroid therapy, and careful monitoring of vital signs.