Vancomycin-induced neutropenia in a patient positive for an antineutrophil antibody.
A 48-year-old man, hospitalized after experiencing subarachnoid hemorrhage secondary to a basilar aneurysm, received vancomycin for methicillin-resistant Staphylococcus aureus sepsis. He developed neutropenia 16 days after the start of vancomycin therapy, and his white blood cell count decreased to a nadir of 1200 cells/mm3. Vancomycin was discontinued, and granulocyte-colony stimulating factor (G-CSF) therapy was begun. The patient was rechallenged with a single dose of vancomycin 1 g in preparation for intraarterial aneurysm coiling. His white blood cell count dropped to 600 cells/mm3 but returned to normal with continued G-CSF therapy. A diagnosis of vancomycin-induced neutropenia was considered. Subsequent testing by granulocyte agglutination and granulocyte immunofluorescence assays revealed that his serum was positive for an antigranulocyte antibody. A test for HLA antibody reactivity was negative. Monoclonal antibody immobilization of granulocyte antigens assay failed to determine the antigen specificity of his granulocyte antibody.
Schwartz
Michael D
MD
Department of Emergency Medicine, University of Cincinnati, Ohio 45267-0769, USA. schwarmd@fuse.net
D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001323:Autoantibodies / Q000032:analysis*; D001772:Blood Cell Count; D005455:Fluorescent Antibody Technique; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced* / Q000276:immunology; D009504:Neutrophils / Q000276:immunology*; D011994:Recombinant Proteins; D012141:Respiratory Tract Infections / Q000097:blood / Q000188:drug therapy / Q000382:microbiology; D013183:Sputum / Q000382:microbiology; D014640:Vancomycin / Q000009:adverse effects* / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D001323:Autoantibodies; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D014640:Vancomycin