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American Academy of Pediatrics, Pediatrics, 6(136), p. e1641-e1645, 2015

DOI: 10.1542/peds.2015-0996

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Neonatal Sulfhemoglobinemia and Hemolytic Anemia Associated With Intestinal Morganella morganii

Journal article published in 2015 by K. Murphy, C. Ryan, E. M. Dempsey ORCID, P. W. OToole, R. P. Ross, C. Stanton, C. A. Ryan
This paper is made freely available by the publisher.
This paper is made freely available by the publisher.

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Abstract

Sulfhemoglobinemia is a rare disorder characterized by the presence of sulfhemoglobin in the blood. It is typically drug-induced and may cause hypoxia, end-organ damage, and death through oxygen deprivation. We present here a case of non–drug-induced sulfhemoglobinemia in a 7-day-old preterm infant complicated by hemolytic anemia. Microbiota compositional analysis of fecal samples to investigate the origin of hydrogen sulphide revealed the presence of Morganella morganii at a relative abundance of 38% of the total fecal microbiota at the time of diagnosis. M morganii was not detected in the fecal samples of 40 age-matched control preterm infants. M morganii is an opportunistic pathogen that can cause serious infection, particularly in immunocompromised hosts such as neonates. Strains of M morganii are capable of producing hydrogen sulphide, and virulence factors include the production of a diffusible α-hemolysin. The infant in this case survived intact through empirical oral and intravenous antibiotic therapy, probiotic administration, and red blood cell transfusions. This coincided with a reduction in the relative abundance of M morganii to 3%. Neonatologists should have a high index of suspicion for intestinal pathogens in cases of non–drug-induced sulfhemoglobinemia and consider empirical treatment of the intestinal microbiota in this potentially lethal condition.