{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T23:16:47Z","timestamp":1790983007207,"version":"4.1.0"},"reference-count":0,"publisher":"Greater Baltimore Medical Center","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Community Hospital Internal Medicine Perspectives"],"abstract":"<jats:p>Background: Drug-induced immune hemolytic anemia (DIIHA) secondary to piperacillin has an estimated incidence of 0.01\u20130.10% [1,2]. In patients with intestinal failure-associated liver disease (IFALD), chronic conjugated hyperbilirubinemia obscures typical hemolytic markers [3,4].\nCase Presentation: A 27-year-old woman with traumatic short bowel syndrome requiring total parenteral nutrition for 6 months, IFALD (baseline total bilirubin 2.5 mg\/dL), and chronic kidney disease experienced three piperacillin-tazobactam exposures over two months. First exposure (12 days): hemolysis developed after drug discontinuation (primary sensitization). Second exposure: severe hemolysis occurred within 3 days (anamnestic response) with hemoglobin declining to 5.8 g\/dL, undetectable haptoglobin, elevated LDH, reticulocytosis, and strongly positive DAT (IgG 3+, C3d negative). Total bilirubin remained stable at 9.7 mg\/dL despite severe hemolysis. Peripheral smear showed spherocytes and polychromasia without schistocytes. Naranjo score was 10 (definite causality) [5]. Treatment included drug discontinuation, corticosteroids, and transfusion with resolution within 8 days. Third exposure (6 days): no hemolysis occurred. At 5-month follow-up, hemoglobin returned to baseline at 9.7 g\/dL.\nConclusions: When baseline cholestasis masks unconjugated bilirubin elevation, diagnosis requires non-bilirubin hemolytic markers,\u00a0peripheral smear, and positive IgG DAT. Immediate drug discontinuation is essential, with favorable prognosis in most cases.<\/jats:p>","DOI":"10.55729\/2000-9666.1617","type":"journal-article","created":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T00:51:30Z","timestamp":1784422290000},"source":"Crossref","is-referenced-by-count":1,"title":["Piperacillin-Induced Immune Hemolytic Anemia Masked by Intestinal Failure-Associated Liver Disease: A Case Report with Three Serial Exposures"],"prefix":"10.55729","volume":"16","author":[{"given":"Stephanie","family":"Ammari","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, HCA Houston Healthcare\/University of Houston\u2013Clear Lake, 500 Medical Center Blvd, Webster, TX 77598, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nawras","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, HCA Houston Healthcare\/University of Houston\u2013Clear Lake, 500 Medical Center Blvd, Webster, TX 77598, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalid","family":"Mahmood","sequence":"additional","affiliation":[{"name":"Medical Oncology, Texas Oncology\u2013Deke Slayton Cancer Center, 501 W. Medical Center Blvd, Webster, TX 77598, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"34701","published-online":{"date-parts":[[2026,7,17]]},"container-title":["Journal of Community Hospital Internal Medicine Perspectives"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T09:52:46Z","timestamp":1788601966000},"score":1,"resource":{"primary":{"URL":"https:\/\/scholarlycommons.gbmc.org\/jchimp\/vol16\/iss4\/15"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,17]]},"references-count":0,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,7,17]]}},"URL":"https:\/\/doi.org\/10.55729\/2000-9666.1617","relation":{},"ISSN":["2000-9666"],"issn-type":[{"value":"2000-9666","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,17]]}}}