title: [Agranulocytosis caused by infectious-toxic bone marrow damage after Borrelia infection].
abstract: A 19-year-old girl developed a fever of up to 40 degrees C and, during an episode of high fever, generalized seizures. Physical examination on admission was unremarkable, except for several small lymph nodes. Differential blood count showed a leukopenia (1700/microliters) with 14% stab and 7% segmented neutrophils. After initial clinical improvement she again became feverish and the differential count now showed agranulocytosis with a total white cell count of 1400/microliters. Because of the time of year and the geographic location borreliosis was now considered in the differential diagnosis. The antibody titre against Borrelia was raised to 1:64 (IgM) and 1:256 (IgG). Her condition and the differential blood count rapidly improved on intravenous antibiotic treatment with cefotiam (2 g two times daily) and gentamicin (120 mg two times daily), as well as filgrastim (granulocyte-colony stimulating factor) subcutaneously. Antibiotic treatment was continued after 6 days with oral ampicillin (1 g three times daily) for 3 weeks. Follow-up examination six weeks later found the patient to be symptom-free.
authors.affiliation: I. Medizinische Abteilung, Städtisches Krankenhaus München-Schwabing.
authors.forename: T
authors.initials: T
authors.lastname: Kamp
authors.forename: C
authors.initials: C
authors.lastname: Zink
authors.forename: C
authors.initials: C
authors.lastname: Beer
authors.forename: W
authors.initials: W
authors.lastname: Kaboth
authors.forename: C
authors.initials: C
authors.lastname: Nerl
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000380:Agranulocytosis / Q000209:etiology*; D000667:Ampicillin / Q000008:administration & dosage; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008193:Lyme Disease / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D013997:Time Factors
chemical_list: D000667:Ampicillin
vernacular_title: Agranulozytose durch infektiös-toxische Knochenmarkschädigung nach Borrelien-Infektion.