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Vancomycin‐Induced Neutropenia in a Patient Positive for an Antineutrophil Antibody
Author(s) -
Schwartz Michael D.
Publication year - 2002
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.22.9.783.34059
Subject(s) - medicine , neutropenia , vancomycin , granulocyte , antibody , leukapheresis , granulocyte colony stimulating factor , white blood cell , immunology , gastroenterology , staphylococcus aureus , chemotherapy , biology , stem cell , bacteria , cd34 , genetics
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/mm 3 . 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/mm 3 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.