Cefazolin

Abstract

Haemolytic anemia and eosinophilia: case reportAn 80-year-old woman developed haemolytic anaemia and eosinophilia during treatment with cefazolin for methicillin-sensitive Staphylococcus aureus (MSSA) endocarditis.The woman presented to the hospital due to shortness of breath and back pain for 4 days. Her medical history was significant for hypertension, minor penicillin allergy, gout, hypothyroidism, hyperlipidaemia, diastolic dysfunction, non ST-elevation myocardial infarction and transient ischaemic attack. Initial urinalysis revealed elevated troponin and leucocytes/bacteria. A CT angiogram chest showed bibasilar atelectasis or consolidation suggestive of a pneumonia. Later, she was diagnosed with severe sepsis secondary to bacterial pneumonia and urinary tract infection, and was started on piperacillin/tazobactam, vancomycin and azithromycin. She experienced acute anaemia and a GI bleeding was suspected. An oesophagogastroduodenoscopy showed a gastric ulcer with visible vessels. She was then treated with unspecified medication and her Hb stabilised. Subsequently, she was diagnosed with MSSA with mitral valve endocarditis, and her antibiotic therapy was changed to IV cefazolin [dosage not stated]. On fifth day after switching to cefazolin, her eosinophil count was found elevated. On day 7, her Hb level started to decrease.The woman was admitted and required multiple blood transfusions. An oesophagogastroduodenoscopy revealed a healing gastric ulcer with no bleeding. Lab tests revealed elevated LDH and indirect bilirubin levels with low haptoglobin. Schistocytes also appeared on a peripheral blood smear test. Based on all the findings, cefazolin-induced haemolytic anaemia and eosinophilia were diagnosed. Cefazolin was switched to vancomycin. Thereafter, her Hb level increased gradually and eosinophil count resolved. She was then discharged and continued on vancomycin for 6 weeks.