Abstract
We would like to report the case of a 69-year-old man who visited a local physician after suffering from abdominal pain and fever that lasted for a week. The patient was diagnosed as having mesenteric adenitis, and levofloxacin (LVFX) was prescribed. However, his symptoms did not improve, and the patient was admitted to our hospital two days later. The antibiotic LVFX was changed to cefmetazole, and the condition of the patient was monitored. Three days after admission, nausea, decreased blood pressure, brown urine, and yellowing of the eyeballs were observed, and significant anemia (Hb level, 6.7 g/dL) and hemolysis were observed in a blood test. On Day 4, his anemia advanced (Hb level, 4.0 g/dL) and positivity for autoantibodies was shown by the direct antiglobulin test (DAT) and indirect antiglobulin test (IAT) carried out as a pretransfusion test, and autoimmune hemolytic anemia was diagnosed. On Days 4 and 5, two units of packed red blood cells were transfused, and steroid pulse therapy was initiated on Day 5. Improvement in anemia conditions and a rapid decrease in the number of autoantibodies were observed. Negative IAT and DAT results were obtained on Days 13 and 28, respectively. A drug lymphocyte stimulation test was carried out on Day 43, which showed positivity for LVFX. In this patient, on the basis of his clinical course, drug-induced immune hemolytic anemia (DIIHA) was presumed to be induced by LVFX. Although a rare disease, there are reports of DIIHA caused by frequently used drugs such as antibiotics and antihypertensive agents. Thus, the possibility of DIIHA should be considered in connection with their use. As seen in this case, symptoms can become severe; thus, it is important that we do not overlook hemolytic anemia and keep in mind the possibility of DIIHA when DAT results are positive.
