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03 September 2018 : Case report  Argentina

Agranulocytosis Induced by Vancomycin. Case Report and Literature Review

Unusual or unexpected effect of treatment, Adverse events of drug therapy

Horacio di Fonzo1ABCDEFG*, Melina Villegas Gutsch1BDF, Augusto Castroagudin1BF, María Victoria Cabrera1BF, Mariano E. Mazzei1ADF, Darío Rueda1ABDEF

DOI: 10.12659/AJCR.909956

Am J Case Rep 2018; 19:1053-1056

Abstract

BACKGROUND: Vancomycin has been used for decades to treat infections by Gram-positive bacteria, particularly those caused by methicillin-resistant staphylococci. Agranulocytosis is an infrequent complication of this antibiotic, postulated in its genesis a mechanism immune-mediated by antineutrophil antibodies and antineutrophil cytoplasm antibodies (ANCA). Treatment includes discontinuing vancomycin, and granulocyte colony-stimulating factor administration.

CASE REPORT: We present the case of a patient who developed agranulocytosis secondary to vancomycin during the treatment of an infectious endocarditis, which was reversed when the antibiotic was stopped. Concomitantly to neutropenia, he had ANCA positivity, which subsequently became negative.

CONCLUSIONS: Agranulocytosis induced by vancomycin is infrequent and generally occurs after day 12 of treatment. In most cases, like in our case, it is caused by an immune-mediated mechanism. More studies are needed to determine the pathogenic mechanism and the ANCA role in this adverse effect.

Keywords: agranulocytosis, Antibodies, Antineutrophil Cytoplasmic, Vancomycin

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923