Ceftriaxone-Induced Reversible Agranulocytosis: A Case Report and Review of Drug-Induced Agranulocytosis

Abstract

In the modern era of medicine, agranulocytosis is a rare occurrence. Despite significant improvement in patient survival, it still carries significant mortality. Agranulocytosis is most commonly caused by chemotherapeutic agents and numerous non-chemo drugs. As it can develop anytime during treatment and patients can remain asymptomatic, frequent cell count monitoring is an essential tool to make a timely diagnosis. An appropriate drug switch, work up to rule out infection and granulocyte colony-stimulating factor (G-CSF) injection in high-risk cases is the management. The patient should be kept under observation till the resolution of agranulocytosis. We present a case of ceftriaxone-induced agranulocytosis which was completely reversible upon stoppage of drug and granulocyte colony-stimulating factor administration. The pathogenesis of ceftriaxone-induced agranulocytosis is unknown. It is suggested to occur either by an immunologic mechanism or because of direct drug toxicity.

Ceftriaxone-Induced Neutropenia Successfully Treated With Alternative β-Lactam Antibiotics: A Case Report and Review of the Literature

“…In our case, ampicillin sodium was administered after the recovery of the neutrophil count because β-lactam antibiotics are superior to vancomycin as definitive therapy for a patient with MSSA bloodstream infections [ 5 ] and because of the unavailability of nafcillin or oxacillin in Japan [ 18 ]. Although mild eosinophilia was observed, the patient was also treated safely with ampicillin sodium, which did not cause neutropenia from β-lactam cross-reactivity.…”

“…Ceftriaxone-induced neutropenia has also been reported in a few clinical cases. Despite β-lactam antibiotics being superior to non-β-lactam antibiotics in certain situations, such as for treating methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia [ 3 ], few studies have examined the use of alternative β-lactam antibiotics for the treatment of ceftriaxone-induced neutropenia [ 4 , 5 , 6 ]. We describe a case of a male patient who developed neutropenia while receiving high doses of ceftriaxone (4 g/day) for infective endocarditis with central nervous complications, which resolved after the cessation of the medication; his neutropenia did not relapse after the medication was replaced with ampicillin sodium.…”

"Case Series of Ceftriaxone-Induced Neutropenia and Leukopenia: Experience in Outpatient Parenteral Antimicrobial Therapy (OPAT) Setting"

“…Neutropenia and leukopenia are listed as common or very common side effects of ceftriaxone in the British National Formulary, while very severe neutropenia (agranulocytosis) is listed as rare or very rare [12]. Despite so, there are relatively few case reports published on ceftriaxone-induced neutropenia [13,14], especially in an outpatient parenteral antimicrobial therapy (OPAT) setting [15,16], where long courses of ceftriaxone, ranging from 2 to 6 weeks, are administered. The Medicines and Healthcare products Regulatory Agency (MHRA) Yellow Card interactive drug analysis shows that only 63 cases of neutropenia and 10 cases of leukopenia were reported between the 1989 and November 2023 [17], highlighting a need for increasing awareness of identifying and monitoring for ceftriaxone-induced neutropenia and leukopenia.…”