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Case report
Acute kidney injury as the presenting complaint of ceftazidime-induced immune-mediated haemolysis
  1. Ashley Ferro1,
  2. Meryl Griffiths2,
  3. Rona Smith1 and
  4. Andrew Fry1
  1. 1 Department of Nephrology, Addenbrooke's Hospital, Cambridge, UK
  2. 2 Department of Histopathology, Addenbrooke's Hospital, Cambridge, UK
  1. Correspondence to Dr Ashley Ferro; ashley.ferro{at}


We present the case of ceftazidime-induced immune-mediated haemolysis with associated acute kidney injury in a 43-year-old woman. The patient initially presented to the regional cystic fibrosis centre for treatment of an infective exacerbation of cystic fibrosis. After initiation of ceftazidime (a third-generation cephalosporin), renal function rapidly deteriorated and a fall in haemoglobin was noted. On transfer to our care, a haemolysis screen identified immune-mediated haemolysis, and renal biopsy confirmed the finding of acute tubular necrosis secondary to haem pigment. The patient’s renal function deteriorated such that she required haemodialysis, although she subsequently recovered and is now dialysis-independent. Although acute haemolytic reactions are recognised with third-generation cephalosporins, this is the first reported case of ceftazidime-induced immune-mediated haemolysis with acute kidney injury. Given the increased frequency of cephalosporin usage, it is important for both nephrologists and general physicians to be aware of this rare but very serious complication.

  • contraindications and precautions
  • haematology (drugs and medicines)
  • renal system
  • unwanted effects / adverse reactions
  • acute renal failure

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  • Contributors AFr devised the project. AFe and AFr performed the literature review and produced the initial manuscript. MG was instrumental in analysis of histopathological specimens and provided images for the manuscript. RS provided input on diagnosis and contributed to refining the manuscript discussion. Moreover, all authors contributed to critical feedback and manuscript revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.