Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment, offering durable responses across multiple malignancies. However, these agents can trigger severe immune-related adverse events (irAEs), including drug-induced autoimmune hemolytic anemia (AIHA), which often necessitates treatment discontinuation. While management guidelines for irAEs are well established, the safety and feasibility of ICI rechallenge after resolution of severe hematologic toxicities remain poorly understood. We herein present a case of pembrolizumab-induced warm autoimmune hemolytic anemia that was successfully rechallenged with dostarlimab. In this case report, we describe a 66-year-old female with a history of stage III C2 endometrial cancer who is status post total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. She had completed six cycles of adjuvant chemotherapy with paclitaxel and carboplatin. At her 12-month follow-up, elevated CA-125 levels and imaging (CT Abdomen Pelvis with PET/CT) indicated possible disease recurrence at the vaginal cuff. A subsequent vaginal biopsy confirmed relapse and recurrence of endometrioid adenocarcinoma with squamous differentiation. Given that the tumor is MMR deficient, the patient was started on pembrolizumab along with carboplatin and paclitaxel. However, after the third cycle, she developed IgG-positive warm autoimmune hemolytic anemia, attributed to pembrolizumab, leading to the discontinuation of the drug. She was treated with steroids, resulting in the resolution of her AIHA, and was then re-challenged with dostarlimab and is showing promising results thus far. Our case demonstrates that rechallenge with alternative immune checkpoint inhibitors may be feasible in selected patients who have experienced immune-related adverse events. However, this decision requires careful consideration of multiple factors, including the type and severity of the initial immune-related adverse event, the potential consequences of recurrence, and the availability of alternative treatment options.

Secukinumab, an anti-IL-17 monoclonal antibody, has been used to treat psoriasis and psoriatic arthritis since 2015. Several adverse events were reported, such as diarrhea, upper respiratory tract infection, middle ear infection, and neutropenia. Here we report a probable case of autoimmune hemolytic anemia in a 39 years old male with psoriasis and psoriatic arthritis treated with secukinumab. Hemolytic anemia detected after first maintenance dose after completion of induction dose of secukinumab. The patient also had other comorbids, soft tissue infection that also predisposed to autoimmune hemolytic anemia, but secukinumab is still a possible etiology for drug-induced autoimmune hemolytic anemia based on Naranjo´s score. The patient decided to continue secukinumab treatment, interestingly hemoglobin levels improved.

To evaluate the characteristics of autoimmune hemolytic anemia caused by salvianolate by antibody detection and clinical index monitoring. Micro-column gel anti-human globulin method was used for irregular antibody screening and antibody identification. Salvianolate, sodium creatine phosphate and levocarnitine were used to sensitize red blood cells that were compatible with the patient's plasma, and the RBCs were used to test drug antibody in patient plasma respectively. The patient's clinical examination of hemolysis index and blood transfusion effect were analyed retrospectively. The patients were positive for irregular antibody screening, and there were antoanti-Ce antibodies in serum. The erythrocytes sensitized with salvianolate in the patient's serum were positive, while those sensitized with sodium creatine phosphate and levocarnitine were negative. Salvianolate causes drug-induced autoimmune hemolytic anemia in this patient. 丹参多酚酸盐导致自身免疫性溶血性贫血的检测及输血效果评价. 通过药物抗体检测及临床指标监测，评价丹参多酚酸盐导致的自身免疫性溶血性贫血的特点. 应用微柱凝胶抗人球蛋白法进行不规则抗体筛查、抗体鉴定试验；用丹参多酚酸盐、磷酸肌酸钠、左卡尼汀致敏与患者配血相合的红细胞，检测患者血浆中是否存在对应的药物抗体；回顾性分析患者临床溶血指标及输血效果. 患者不规则抗体筛查阳性，血清内存在类抗-Ce联合抗体；患者血清与丹参多酚酸盐致敏的红细胞反应为阳性，与磷酸肌酸钠、左卡尼汀致敏的红细胞反应为阴性. 丹参多酚酸盐导致该患者发生自身免疫性溶血性贫血.

To report a case of hemolytic anemia in a patient who received trimethoprim/sulfamethoxazole (TMP-SMX) for a urinary tract infection (UTI). A 47-year-old woman recently diagnosed with uncomplicated UTI received 3 doses of TMP-SMX. She developed yellowing of the skin and eyes, lethargy, mild abdominal pain, and dry mucous membranes. Laboratory testing demonstrated significant anemia with red blood cells (RBCs) of 1.99, hemoglobin (Hgb) of 6.3 g/dL, and hematocrit (Hct) of 18.1%. TMP-SMX was immediately discontinued. The patient was given methylprednisolone 60 mg intravenously (IV) followed by oral steroids and infused with 3 units of packed RBCs over the course of a 10-day inpatient admission. On discharge, the patient continued oral steroids. Outpatient follow-up indicated Hgb of 11.0 g/dL and Hct of 32.7%, 41 days after hospital discharge. Utilizing the Naranjo adverse drug reaction probability scale, there is a probable association between the patient's hemolytic anemia and TMP-SMX. We report a case of hemolytic anemia resulting from the use of TMP-SMX. Although this is a rare adverse effect, clinicians should be aware of the signs and symptoms of hemolytic anemia, and so appropriate treatment can be administered should it occur.