Medicine · 2025
Life-threatening vancomycin-induced immune hemolytic anemia: A rare case report.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Peng Jiang-Chen, Gao Yuan
Аннотация
RATIONALE: Drug-induced immune hemolytic anemia is a rare but serious cause of autoimmune hemolytic anemia, most frequently triggered by antimicrobials. Vancomycin is an exceedingly rare culprit, with only a handful of cases reported.
PATIENT CONCERNS: A 64-year-old woman developed acute-onset fever, tachycardia, dyspnea, and dark-colored urine on the 7th day after revision knee arthroplasty, during which she was receiving intravenous vancomycin prophylaxis.
DIAGNOSES: Laboratory findings revealed a dramatic drop in hemoglobin, indirect hyperbilirubinemia, elevated lactate dehydrogenase, and reticulocytosis, consistent with hemolysis. The direct antiglobulin test was positive for IgG and C3, confirming immune-mediated hemolysis. A comprehensive workup ruled out infections, autoimmune diseases, and malignancies. The association with vancomycin was categorized as "probable" on the Naranjo scale.
INTERVENTIONS: Vancomycin was immediately discontinued. The patient received intravenous methylprednisolone and immunoglobulins. Due to rapid progression to life-threatening anemia and hemodynamic instability, therapeutic plasma exchange and washed red blood cell transfusions were initiated.
OUTCOMES: Following these interventions, the patient's condition gradually stabilized. Hemoglobin levels improved, hemolytic markers normalized, and she was successfully weaned from mechanical ventilation. She was discharged after 1 month on a prolonged steroid taper, with a full hematologic recovery observed on follow-up.
LESSONS: Vancomycin can induce life-threatening immune hemolytic anemia. Clinicians must maintain a high index of suspicion for drug-induced immune hemolytic anemia in patients with abrupt hemolysis after initiating a new drug, as immediate discontinuation of the offending agent is the cornerstone of management.
PATIENT CONCERNS: A 64-year-old woman developed acute-onset fever, tachycardia, dyspnea, and dark-colored urine on the 7th day after revision knee arthroplasty, during which she was receiving intravenous vancomycin prophylaxis.
DIAGNOSES: Laboratory findings revealed a dramatic drop in hemoglobin, indirect hyperbilirubinemia, elevated lactate dehydrogenase, and reticulocytosis, consistent with hemolysis. The direct antiglobulin test was positive for IgG and C3, confirming immune-mediated hemolysis. A comprehensive workup ruled out infections, autoimmune diseases, and malignancies. The association with vancomycin was categorized as "probable" on the Naranjo scale.
INTERVENTIONS: Vancomycin was immediately discontinued. The patient received intravenous methylprednisolone and immunoglobulins. Due to rapid progression to life-threatening anemia and hemodynamic instability, therapeutic plasma exchange and washed red blood cell transfusions were initiated.
OUTCOMES: Following these interventions, the patient's condition gradually stabilized. Hemoglobin levels improved, hemolytic markers normalized, and she was successfully weaned from mechanical ventilation. She was discharged after 1 month on a prolonged steroid taper, with a full hematologic recovery observed on follow-up.
LESSONS: Vancomycin can induce life-threatening immune hemolytic anemia. Clinicians must maintain a high index of suspicion for drug-induced immune hemolytic anemia in patients with abrupt hemolysis after initiating a new drug, as immediate discontinuation of the offending agent is the cornerstone of management.