Fatal Penicillin-Induced Hemolytic Anemia

To the Editor.—  Since the first report of a circulating antipenicillin antibody by Ley et al¹ in 1958, more than 20 cases of immunohemolytic anemia due to antipenicillin antibodies have been reported. In most cases, the antibody was an IgG related to prolonged high-dose penicillin therapy,² and, although several of the hemolytic episodes were severe, there have been no reported deaths directly attributable to penicillin-induced hemolysis. We report here a case of circulatory collapse and death in a patient with Coombs-positive hemolytic anemia and circulating antipenicillin antibodies.

Report of a Case.—  A 54-year-old woman was hospitalized with cellulitis, fever, aseptic meningitis, a peripheral embolic phenomenon, and dehydration. On admission, the hematocrit value was 31%; hemoglobin level, 10.1 g/dL; and WBC count, 15,600/cu mm, with a left shift. The patient initially received aqueous penicillin G, 3 million units intravenously (IV) every four hours. After rehydration, the hematocrit value was