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Agranulocytosis Induced by Vancomycin. Case Report and Literature Review

Horacio di Fonzo1, Melina Villegas Gutsch1, Augusto Castroagudin1

  • 1Department of Internal Medicine, Hospital de Clínicas "José de San Martin", University of Buenos Aires, Buenos Aires, Argentina.

The American Journal of Case Reports
|September 4, 2018
PubMed

Insights

Vancomycin can rarely cause agranulocytosis, a serious condition of low white blood cells, often due to immune reactions. Stopping the antibiotic typically resolves this adverse effect.

Area of Science:

  • Pharmacology
  • Hematology
  • Infectious Diseases

Background:

  • Vancomycin is a critical antibiotic for Gram-positive bacterial infections, including MRSA.
  • Agranulocytosis is a rare but severe adverse effect associated with vancomycin therapy.
  • Immune-mediated mechanisms involving antineutrophil antibodies and antineutrophil cytoplasm antibodies (ANCA) are implicated in vancomycin-induced agranulocytosis.

Observation:

  • This case report details a patient who developed agranulocytosis during vancomycin treatment for infectious endocarditis.
  • The patient exhibited ANCA positivity concurrently with neutropenia.
  • Resolution of agranulocytosis was observed upon discontinuation of vancomycin.

Findings:

  • Vancomycin-induced agranulocytosis is infrequent, typically manifesting after 12 days of treatment.
  • The adverse effect is predominantly driven by immune-mediated processes.
  • The patient's ANCA positivity resolved as neutropenia improved after vancomycin cessation.

Implications:

  • Understanding the immune-mediated pathogenesis of vancomycin-induced agranulocytosis is crucial.
  • Further research is needed to elucidate the precise role of ANCA in this complication.
  • This case highlights the importance of monitoring for hematological adverse effects during vancomycin therapy.

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