Case of Ceftriaxone-Induced Immune Hemolytic Anemia in an Outpatient Parenteral Antimicrobial Therapy (OPAT) Unit

Background: Ceftriaxone is a commonly used antimicrobial agent for the treatment of various infections. It is frequently administered once daily and is an attractive option for use in both in- and out-patient settings. Ceftriaxone-induced immune hemolytic anemia, while rare, can potentially cause severe and even fatal complications if not identified and managed early.

Case Presentation: We present the case of a 59-year-old Korean female with hypertension, hyperlipidemia, diabetes, and no known prior allergies, who was being treated for pyelonephritis in our outpatient parenteral antimicrobial therapy (OPAT) infusion unit with ceftriaxone. A few days following antibiotic exposure she was admitted to the hospital and her laboratory values were most consistent with hemolysis. All values normalized following discontinuation of ceftriaxone and initiation of ertapenem.

Conclusion: This case describes the clinical course, alternative diagnosis as well as the severity of ceftriaxone induced immune hemolytic anemia. While a rare phenomenon, it can be potentially fatal. Furthermore, it validates the importance of prompt identification and withdrawal of the offending agent may limit the progression of this disease, especially in the outpatient setting, where patients are not as closely monitored.