ACUTE HEMOLYTIC ANEMIA, AUTOAGGLUTINATION, TOXIC HEPATITIS AND RENAL DAMAGE FOLLOWING SULFATHIAZOLE THERAPY; CASE REPORT

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Abstract
65 gs. of sulfathiazole were given over a 2 wk. period in the treatment of a pneumococcus type VII lobar pneumonia. 24 hrs. after sulfathiazole was discontinued there suddenly occurred weakness, stupor, jaundice and peripheral vascular collapse. There was laboratory evidence of acute hemolytic anemia (red-colored urine giving a strongly positive benzidine reaction with few or no red cells, positive urinary urobilinogen up to 1:125, erothro-cytes which rapidly fell to 1,790,000 with 30% Hb, icterus index of 37.5, and a mean corpuscular thickness of 3.1 [mu]); of toxic hepatitis (direct immediate van den Bergh, hippuric acid synthesis in which less than 1 g. was excreted, bromsulphalein test showing 85% retention after 30 mins., low blood cholesterol of 137.5 mg.%, diminished total protein of 5.34% with a 1:1 albumin-globulin ratio and no fibrinogen, and the presence of bile and urobilinogen in the urine); of renal damage (coarsely granular casts and renal parenchymal cells in the urine, and moderate azotemia); and of marked regenerative bone marrow activity (leukocytosis reaching 67,400, nucleated red cells totaling 4,400, blood platelets 590,000, reticulocytes 11:2%, and a marked shift to the left). The patient''s serum exhibited panagglutination and autoagglutination and the blood smear microspherocytosis. Transfusions were given and recovery occurred.