LAUSR

An 82-year-old Chinese female known to have erythrodermic pemphigus with background of psoriasis was started on dapsone for 4 months prior to admission. She was then admitted due to delirium and desaturation. On admission, oxygen saturation was 89% on room air, which subsequently improved with high flow oxygen therapy. The full blood count showed hemoglobin 11.2 g/dL (reference range: 13.6–16.6 g/dL), white blood cells 23.9 × 10/L (reference range: 4.0–9.6 × 10/L), platelets 362 × 10/L (reference range: 150–360 × 10/L) and reticulocyte counts 220.8 × 10/L (reference range: 25–85 × 10/L). Markers of hemolytic anemia were present, including an elevated LDH at 730 U/L (reference range: 270–550 U/L), elevated total bilirubin 54 mmol/L (reference range: 5–30 mmol/L) and IMAGE 1 Image 1A: Features of red cell oxidative hemolysis including bite cells (yellow arrow), blister cells (green arrow) and irregularly contracted cells (orange arrow) on a background of polychromasia. There are also Howell-Jolly bodies seen (blue arrow). Image 1B: Dyserythropoietic changes in the red cell series showing Pappenheimer bodies (yellow arrow) on the background of oxidative hemolysis showing bite cells (green arrow). Image 1C: Dyserythropoietic changes in the red cell series showing Howell-Jolly Bodies (blue arrow) on the background of oxidative hemolysis showing bite cells (green arrow) Received: 1 January 2021 Revised: 24 January 2021 Accepted: 28 January 2021