{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T15:52:24Z","timestamp":1783612344548,"version":"3.55.0"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T00:00:00Z","timestamp":1714608000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Drug-induced immune hemolytic anemia (DIIHA) is a rare but serious condition, with an estimated incidence of one in 100,000 cases, associated with various antibiotics. This study reports on a case of ceftizoxime-induced hemolysis observed in a patient in China.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case description<\/jats:title><jats:p>A Chinese patient diagnosed with malignant rectal cancer underwent antimicrobial therapy after laparoscopic partial recto-sigmoid resection (L-Dixon). After receiving four doses of ceftizoxime, the patient developed symptoms including rash, itchy skin, and chest distress, followed by a rapid decline in hemoglobin levels, the presence of hemoglobin in the urine (hemoglobinuria), renal failure, and disseminated intravascular coagulation. Laboratory analysis revealed high-titer antibodies against ceftizoxime and red blood cells (RBCs) in the patient\u2019s serum, including immunoglobulin M (IgM) (1:128) antibodies and immunoglobulin G (IgG) (1:8) antibodies, with noted crossreactivity to ceftriaxone. Significant improvement in the patient\u2019s hemolytic symptoms was observed following immediate discontinuation of the drug, two plasma exchanges, and extensive RBC transfusion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This case, together with previous reports, underscores the importance of considering DIIHA in patients who exhibit unexplained decreases in hemoglobin levels following antibiotic therapy. A thorough examination of the patient\u2019s medical history can provide crucial insights for diagnosing DIIHA. The effective management of DIIHA includes immediate cessation of the implicated drug, plasma exchange, and transfusion support based on the identification of specific drug-dependent antibodies through serological testing.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2024.1390082","type":"journal-article","created":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T04:23:30Z","timestamp":1714623810000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Case report: Decreased hemoglobin and multiple organ failure caused by ceftizoxime-induced immune hemolytic anemia in a Chinese patient with malignant rectal cancer"],"prefix":"10.3389","volume":"15","author":[{"given":"Can","family":"Lou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liu","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Long","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaming","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hang","family":"Lei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong","family":"Xiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuefeng","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohong","family":"Cai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,5,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1182\/asheducation-2009.1.73","article-title":"Drug-induced immune hemolytic anemia","author":"Garratty","year":"2009","journal-title":"Hematol Am Soc Hematol Educ Program"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2011.08784.x","article-title":"Drug induced immune haemolytic anaemia in the Berlin Case-Control Surveillance Study","volume":"154","author":"Garbe","year":"2011","journal-title":"Br J Haematol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1517\/14740338.2012.678832","article-title":"Immune hemolytic anemia caused by drugs","volume":"11","author":"Garratty","year":"2012","journal-title":"Expert Opin Drug Saf"},{"key":"B4","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1186\/s12882-023-03235-w","article-title":"Piperacillin-tazobactam induced immune hemolytic anemia led to increased renal impairment and eventual death from multiple organ failure in a patient with hypertensive nephropathy: case report and literature review","volume":"24","author":"Wu","year":"2023","journal-title":"BMC Nephrol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1186\/s40360-018-0257-7","article-title":"Ceftriaxone-induced hemolytic anemia with severe renal failure: a case report and review of literature","volume":"19","author":"Leicht","year":"2018","journal-title":"BMC Pharmacol Toxicol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(66)92290-2","article-title":"Methyldopa and hemolytic anemia","volume":"2","author":"Weiner","year":"1966","journal-title":"Lancet"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.blre.2010.06.004","article-title":"Immune hemolytic anemia associated with drug therapy","volume":"24","author":"Garratty","year":"2010","journal-title":"Blood Rev"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1053\/j.seminhematol.2005.04.004","article-title":"The changing spectrum of drug-induced immune hemolytic anemia","volume":"42","author":"Arndt","year":"2005","journal-title":"Semin Hematol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1001\/jama.233.5.432","article-title":"Penicillin-induced immune hemolytic anemia. 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