International Journal of Clinical & Medical Images

A 19-year-old male patient was admitted to the hospital with a fever and cough. His chest X-ray showed right lower lobe infiltration consistent with the diagnosis of pneumonia. On the fifth day after admission, he started complaining about dark urine and jaundice, and his hemoglobin level dropped from 14 g/dl to 8 g/dl, with up regulation of unconjugated bilirubin. The nurses noticed clotting of his blood immediately after they drew the blood. A blood smear without magnification on the left side in Figure 1 (panel A) is the control; the patient’s blood smear (panel B) showed clumps before staining. Warming to 37°C at room temperature caused his blood to undergo agglutination (Figure 2, arrow). Results of a cold-agglutinin test were strongly positive (anti-I). Serological testing for mycoplasma showed a high titer of anti-mycoplasma IgM (without IgG). The patient was treated with levofloxacin and showed an excellent response; his cold agglutinin disease resolved. As seen in the current patient, potent cold agglutinins can cause specific problems, especially when reactivity persists at temperatures above room temperature. The acute form of cold agglutinin disease is often secondary to mycoplasma infection or lymphoproliferative disorders