The occurrence of acute hemolysis in a patient with stable hemoglobinosis can be of corpuscular or extra-corpuscular origin. We report the case of a patient with sickle cell disease SS stable for twenty years, who is treated with levofloxacin for sepsis with a urinary starting point. Biology: hyperleukocytosis at 33,570/mm3 made up of 90% neutrophils and CRP at 160 mg/l, hemolytic, mechanical, nonthrombocytic microcytic anemia (Hb at 8.3 g/dl, VGM at 70 μm3, haptoglobulin collapsed < 0.1, weakly positive schistocytes < 0.1%, PL at 277,000 with no evidence for DIC, the fibrinogen level is rather high at 5.68 g/l and hemostasis is normal. blood ionogram, renal function is normal with blood urea at 4 mmol/l and creatinine at 62 μmol/l. The rest of the blood ionogram are normal apart from the proteins which are contracted at 93 g/l. The liver test shows a Bilirubin total at 144 UI/L, Conjugated bilirubin at 38 UI/L, Free Bilirubin at 106 UI/L, PAL at 166, ASAT and ALAT at 50 UI/L, GGT, Amylase are normal. The iron balance is rather inflammatory with low serum iron at 8 μmol/l, saturation at 13% and high serum ferritin at 462 μg/l ECBU comes back positive for entero bacter chloacae with significant leukocyturia at more than 100,000/ml associated with hematuria at 25,000/ml complicated by bacteremia with the same germ. The evolution is marked by the persistence of haemolytic signs despite the regression of inflammatory markers. Levlofloxacin unmasks a G6PD deficiency. The substitution of levolofloxacin by cefixime allows a clear clinical and biological improvement.
Cite this paper
Balde, M. C. , Balde, M. S. , Bah, A. B. , Diallo, M. F. , Cherif, I. , Spataru, L. , Awada, Z. , Caumette, L. , Cadeac, M. A. , Delmas, B. , Roque, P. M. D. L. , Thomazeau, J. , Bah, A. , Bah, M. S. , Kaba, M. L. and Bah, A. O. (2023). Hemolysis Supported by Levofloxacin in an SS Sickle Cell Patient. Open Access Library Journal, 10, e193. doi: http://dx.doi.org/10.4236/oalib.1110193.
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