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Bei Makrohämaturie auch an Medikamentenanamnese denken

Penicillininduzierte Immunhämolyse: ein Fallbericht mit Literaturreview

In macrohematuria, medication history also needs to be considered

Penicillin-induced immune hemolysis: a case report and review of literature

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Zusammenfassung

Hintergrund

Medikamentenvermittelte Immunhämolysen sind seltene, aber potenziell lebensbedrohliche Krankheitsbilder. Ausgehend vom Fallbeispiel einer penicillininduzierten Immunhämolyse wurde ein strukturiertes Literaturreview der bisher publizierten Fallberichte und -studien zur Immunhämolyse durch diese Präparategruppe durchgeführt.

Fallbericht

Ein 28-jähriger Mann stellte sich mit Makrohämaturie und unspezifischen abdominellen Beschwerden in der Notaufnahme vor. Seit 10 Tagen bestand ein respiratorischer Infekt mit bakterieller Tonsillitis, die ambulant oral mit Penicillin V behandelt wurde. Labordiagnostisch wurden pathologische direkte und indirekte Hämolyseparameter nachgewiesen. Nach Absetzen des Medikaments stabilisierte sich der Zustand des Patienten.

Schlussfolgerungen

Die Diagnose der penicillinvermittelten Immunhämolyse erfordert die strukturierte Zusammenarbeit von Klinik und Labor, da klinische wie auch serologische Befunde eine hohe Variabilität mit dem Risiko von Fehldiagnosen aufweisen können. Diese Publikation soll bei Auftreten der Trias abrupter Hämoglobinabfall in Zusammenhang mit einer medikamentösen Therapie und einem stark positiven Coombs-Test aufgrund ihrer Seltenheit für die Erkrankung sensibilisieren.

Abstract

Background

Drug-mediated immune hemolysis is a rare but potentially life-threatening condition. Based on a case of penicillin-induced immune hemolysis, a structured literature review of case reports and studies on penicillin-mediated Drug-Induced Immune Hemolytic Anemia (DIIHA) was carried out.

Case report

A 28-year-old male patient presented to the emergency department with gross hematuria and non-specific abdominal complaints. The patient had a 10-day history of respiratory infection with bacterial tonsillitis, treated orally with penicillin V on an outpatient basis. Laboratory diagnostics detected pathologically altered direct and indirect hemolysis parameters. After stopping the medication, the patient’s condition could be stabilized.

Conclusion

Diagnosis of penicillin-mediated immune hemolysis requires structured cooperation between clinic and laboratory, as clinical and serological findings may be highly variable with the risk of misdiagnosis. Due to the rarity of the disease, this case report is intended to raise awareness with respect to the triad of abrupt drop in hemoglobin levels in connection with drug therapy and in combination with a strongly positive direct Coombs test.

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Authors and Affiliations

  1. Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland

    K. Schlatterer

  2. Institut für Laboratoriumsmedizin, Sankt Gertrauden-Krankenhaus, Paretzer Str. 12, 10713, Berlin, Deutschland

    K. Schlatterer

  3. Abteilung für Innere Medizin/Kardiologie, Sankt Gertrauden-Krankenhaus, Berlin, Deutschland

    M. Marschner & C. Hausdorf

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  1. K. Schlatterer
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  3. C. Hausdorf
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Correspondence to K. Schlatterer.

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K. Schlatterer, M. Marschner und C. Hausdorf geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Für Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts, über die Patient/-innen zu identifizieren sind, liegt von ihnen und/oder ihren gesetzlichen Vertretern/Vertreterinnen eine schriftliche Einwilligung vor.

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H. Haller, Hannover (Schriftleitung)

B. Salzberger, Regensburg

C.C. Sieber, Nürnberg

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Schlatterer, K., Marschner, M. & Hausdorf, C. Bei Makrohämaturie auch an Medikamentenanamnese denken. Innere Medizin 64, 1218–1223 (2023). https://doi.org/10.1007/s00108-023-01555-5

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