Severe bactrim-induced neutropenia with reversal of CD4⁺ /CD8⁺ lymphocyte ratio: response to recombinant human granulocyte-colony stimulating factor (R-metHUG-CSF)

Abstract

A patient presented with severe bactrim-induced neutropenia with a reversed CD4+/CD8+ lymphocyte ratio. R-metHUG-CSF at 300 micrograms daily produced a dramatic neutrophil response and the therapy was discontinued after 2 weeks.

Agranulocytosis Associated With Use of Sulfamethoxazole/Trimethoprim in a Healthy Adult

“…9 We conducted a review of published cases (Table 2) and noted that the majority of identified cases of agranulocytosis with sulfamethoxazole/trimethoprim reported in the literature were associated with medically complex patients, concomitant medications that may contribute to agranulocytosis, or extended courses of sulfamethoxazole/trimethoprim therapy. [10][11][12][13][14][15][16][17][18] From the review of the literature, it can also be noted that many cases were missing key patient level details such as concomitant medications/comorbidities which limit the ability to interpret likelihood without that key clinical context.…”