Ceftriaxone-Induced Pancytopenia: A Case Report

Area of Science:

• Hematology
• Pharmacology
• Internal Medicine

Background:

• Cephalosporins are generally considered safe antibiotics.
• Rarely, serious hematological abnormalities can occur following cephalosporin therapy.
• This case highlights a potential adverse effect of a widely used antibiotic.

Observation:

• A 72-year-old female developed pancytopenia after five days of ceftriaxone treatment for a urinary tract infection.
• Extensive diagnostic workup excluded other causes of cytopenia.
• Bone marrow aspiration revealed hypocellularity without malignancy; peripheral smear showed no dysplasia or hemolysis.

Findings:

• Ceftriaxone was identified as the likely cause of drug-induced pancytopenia.
• Discontinuation of ceftriaxone and administration of granulocyte colony-stimulating factor (G-CSF) resulted in significant clinical improvement.
• The patient's recovery suggests an idiosyncratic, immune-mediated mechanism.

Implications:

• Clinicians should maintain a high index of suspicion for drug-induced cytopenias in patients receiving antibiotics.
• Thorough medication history and exclusion of alternative causes are crucial for diagnosis.
• Further research into pharmacogenomic screening, particularly involving HLA variants, may identify patients at increased risk for such adverse events.