Hemolysis Supported by Levofloxacin in an SS Sickle Cell Patient

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.