A 67-year-old male patient with a history of tonic-clonic epilepsy without current pharmacological treatment.
She did not use medications, did not report toxic habits or drug allergies.
She was admitted to the emergency room due to a two-day history of abdominal pain associated with jaundice, choluria and general malaise.
Physical examination showed no evidence of loxocelism.
No family history of favismation was recorded.
He was admitted in oliguric acute renal failure requiring dialysis support since his arrival.
On admission, hematocrit 1 was 4.9 g/dL, white blood cells 33,000μL (preserved formula), and mild thrombocytopenia (133,000μL).
Corrected lymphocyte count was 4.6%.
Blood urea nitrogen was 125 mg/dL and creatinine was 3.47 mg/dL (BUN/ Creatinine product 19.2).
The urine sediment showed no hematuria or cylinders and the installation of the Foley catheter described red urine output.
Total bilirubin was 5.7 mg/dL, predominantly indirect (3.2 mg/dL).
Plasma electrolytes at admission were: potassium 4.9 mEq/L, sodium 137 mEq/L, chlorine 99 mEq/L. Arterial gas: pH 7.5, pO2 139, bicarbonate 16.
Direct and indirect Coombs tests were negative.
The patient underwent transfusion of 9 units of red blood cells every other day for 5 days from arrival.
The admission smear was negative for schistocytes and flow cytometry was negative for paroxysmal nocturnal hemoglobinuria.
Due to the possibility of thrombocytopenic purpura (TTP), plasmapheresis was started without clinical improvement.
During his evolution he developed liver and respiratory dysfunction requiring invasive mechanical ventilation and was transferred to the ICU.
During the second week of hospital stay he presented systemic inflammatory response syndrome secondary to infection by S. Aureus, was treated with vancomycin, requiring transient support with vasoactive drugs (dobutamine).
After approximately 1 month of hospitalization, mechanical ventilation was removed and dieresis was removed and the patient was transferred to the Intermediate Care Unit.
She was discharged at 4 days with values of urea nitrogen 17.2 mg/dL and serum creatinine 1.17 mg/dL.
Given the possibility of overestimating the glucose-6-phosphate-dehydrogenase (G6PD) concentration due to a higher number of transfusions performed three months after the hemolytic episode.
This was performed using the colorimetric method of cough and Betke, showing undetectable enzymatic activity.
