Acute kidney injury with dark urine: the case of paroxysmal nocturnal hemoglobinuria

  • Kamel El-Reshaid Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait
  • Hasan Sabri Department of Medicine, kidney unit, Al-Amiri Hospital, Kuwait
  • Shaikha Al-Bader Department of Medicine, kidney unit, Al-Amiri Hospital, Kuwait

Abstract

In this case report; we describe a patient with severe attack of paroxysmal nocturnal hemoglobinuria (PNH) following Ciprofloxacin therapy.  He presented with recurrent abdominal pain, repeated vomiting and dark urine.   Physical examination revealed severe pallor and jaundice.  Laboratory investigations showed severe intravascular hemolysis with negative Coomb’s test, progressive acute kidney injury (AKI), sterile blood cultures and negative serology for autoimmune diseases.  Subsequently, he developed pancytopenia.  Ham test was positive and flow cytometry, later on, confirmed PNH.  He was supported with multiple transfusions of packed blood cells and hemodialysis.  Ciprofloxacin was discontinued and his PNH was treated with Solumedrol 1 g daily for 3 days followed by Prednisone 60 mg/day for 2 months.  Two weeks later; his hemolysis abated and his AKI improved.  Up to 5 years later, he still has minor PNH clone yet without disease activity.  In conclusion; our patient had acute drug-induced hemolytic crisis associated with minor PNH clone.  With drug-vigilance; no further relapses were reported and his PNH clone remained stable for 5 years. The case expands the spectrum of PNH phenotypes and its triggering factors.


Keywords: AKI, anemia, autoimmune, flow cytometry, hemolysis, PNH.

Keywords: AKI, anemia, autoimmune, flow cytometry, hemolysis, PNH

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Author Biographies

Kamel El-Reshaid, Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait

Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait

Hasan Sabri, Department of Medicine, kidney unit, Al-Amiri Hospital, Kuwait

Department of Medicine, kidney unit, Al-Amiri Hospital, Kuwait

Shaikha Al-Bader, Department of Medicine, kidney unit, Al-Amiri Hospital, Kuwait

Department of Medicine, kidney unit, Al-Amiri Hospital, Kuwait

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El-Reshaid K, Sabri H, Al-Bader S. Acute kidney injury with dark urine: the case of paroxysmal nocturnal hemoglobinuria. JDDT [Internet]. 15Aug.2020 [cited 23Apr.2021];10(4-s):1-. Available from: http://jddtonline.info/index.php/jddt/article/view/4196

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