title: G-CSF enables completion of tuberculosis therapy associated with iatrogenic neutropenia.
abstract: Neutropenia is a rare complication of anti-tuberculous therapy and is usually due to a single agent, most frequently isoniazid. The current case describes a previously healthy immunocompetent patient with tuberculosis of the lymph nodes who developed neutropenia due to a number of first line antibiotics (rifampicin, isoniazid and ethambutol) and streptomycin when introduced in combination and individually thus resulting in repeated treatment disruption. The introduction of twice-weekly subcutaneous granulocyte-colony stimulating factor to correct iatrogenic neutropenia facilitated the continuation and eventual completion of therapy without adverse effect. This is the first description of the use of granulocyte-colony stimulating factor to correct iatrogenic neutropenia due to anti-tuberculous antibiotics and the second description of the occurrence of iatrogenic neutropenia to more than anti-tuberculous antibiotic in an individual.
authors.affiliation: Dept of Respiratory Medicine, Second Floor, Thomas Guy House, Guy's Hospital, St. Thomas Street, London SE1 9RT, UK. liam.cormican@gstt.sthames.nhs.uk
authors.forename: L J
authors.initials: LJ
authors.lastname: Cormican
authors.forename: S
authors.initials: S
authors.lastname: Schey
authors.forename: H J
authors.initials: HJ
authors.lastname: Milburn
mesh_terms: D000328:Adult; D000904:Antibiotics, Antitubercular / Q000009:adverse effects; D000995:Antitubercular Agents / Q000009:adverse effects*; D004977:Ethambutol / Q000009:adverse effects; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D007049:Iatrogenic Disease; D007538:Isoniazid / Q000009:adverse effects; D008297:Male; D009503:Neutropenia / Q000139:chemically induced / Q000188:drug therapy*; D012293:Rifampin / Q000009:adverse effects; D013307:Streptomycin / Q000009:adverse effects; D014388:Tuberculosis, Lymph Node / Q000188:drug therapy*
chemical_list: D000904:Antibiotics, Antitubercular; D000995:Antitubercular Agents; D016179:Granulocyte Colony-Stimulating Factor; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin; D013307:Streptomycin