case_images: PMC11096485_01
case_images: Serum and peripheral smear changes post-ceftizoxime. This figure showed the patient's recovery from dark, soy sauce-colored serum to normal following ceftizoxime cessation (A), and a peripheral blood smear revealed numerous schistocytes, indicating hemolysis (B, red arrow). The scale bar is 8 mum.
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case_images: The patient's plasma (or serum) mirrored the dark hue of soy sauce, and peripheral blood smears revealed an abundance of schistocytes, indicating active hemolysis ( Figure 1 ).
case_images: Hemoglobin levels after hospital admission. Upon admission, the patient's hemoglobin levels remained consistent. However, following the last administration of ceftizoxime via an IV drip, a rapid decrease in hemoglobin was observed within 24 h. Although there was a temporary improvement in hemoglobin levels after receiving multiple RBC transfusions, the ongoing destruction of hemoglobin by drug-dependent antibodies led to a continued decrease. On days 44, 45, 46, and 49, the patient received 2 units of RBCs each day to combat this decline.
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case_images: Despite this, hemolysis continued, causing hemoglobin levels to fluctuate in the subsequent days ( Figure 2 ).
case_images: Agglutination responses to varying ceftizoxime concentrations. The agglutination responses elicited by different concentrations of ceftizoxime were demonstrated using uniform volumes of erythrocytes and the patient's serum. Specifically, the ceftizoxime concentrations in the left and middle tubes were 8 mg/ml and 0.5 mg/ml, respectively, while the right tube contained AB serum without the drug. Our observations revealed a significantly stronger agglutination reaction in the tube with 8 mg/ml ceftizoxime compared to the one with 0.5 mg/ml, highlighting the dose-dependent nature of the agglutination process.
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case_images: Further testing with varying concentrations of ceftizoxime revealed a direct correlation between the drug concentration and the intensity of agglutination ( Figure 3 ).