Sulfadiazine
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Haemolysis in a child with toxoplasmosis and G-6-PD deficiency: case report A boy with toxoplasmosis developed haemolysis after starting treatment with sulfadiazine; subsequent analysis revealed a glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. The boy presented at 5 years of age; investigations revealed toxoplasmosis, and he began receiving treatment including sulfadiazine 100 mg/kg/day. On the day 7 of treatment, he developed jaundice and dark urine. Physical examination revealed splenohepatomegaly, tachycardia and tachypnoea. A diagnosis of hepatitis secondary to medications was considered. He had a haemoglobin level of 6.4g%, a WBC count of 10 200 cells/mm3, a serum bilirubin level of 1.4 mg/dL, a direct bilirubin level of 0.9 mg/dL and normal liver enzymes. A diagnosis of acute haemolysis was considered. Subsequent tests showed a reticulocyte count of 5.1%, a corrected reticulocyte count of 1.7% and negative direct and indirect Coombs tests. His blood smear showed haemolysis, and he was screened for G-6-PD activity which was absent. A diagnosis of acute acquired toxoplasmosis with G-6-PD deficiency was considered with acute haemolysis due to sulfadiazine ingestion. Sulfadiazine was discontinued, and the boy’s treatment was switched to clindamycin. He was eventually discharged without jaundice and with a reticulocyte count and haemoglobin level of 0.5% and 10.0g%, respectively. At follow-up, after 1 month, his haemoglobin level was 12.5g%. Because of his G-6-PD deficient state, his parents were advised to avoid numerous drugs including antimalarials, sulfa drugs, chloramphenicol, nitrofurantoin, nalidixic acid and Vitamin K. Nunes AA. Patient with toxoplasmosis and glucose-6-phosphate dehydrogenase deficiency: A case report. Cases Journal 2: Aug 2009. Available from: URL: http:// 803010487 dx.doi.org/10.4076/1757-1626-2-8826 - Brazil
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Reactions 17 Apr 2010 No. 1297
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