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A Puerperal Patient with Leukopenia During Vancomycin Administration: A Case Report and Review of the Literature
Lidija Tulic1,2, Katarina Ivanovic1, Ivan Tulic1
1Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11 000 Belgrade, Serbia.
Insights
Prolonged antibiotic use can lead to rare but serious agranulocytosis, a severe drop in white blood cells. Early detection and treatment with G-CSF are crucial for recovery, especially in postpartum patients.
Area of Science:
- Hematology
- Infectious Diseases
- Pharmacology
Background:
- Antibiotic therapy is vital for bacterial infections but carries risks of rare hematological side effects like leukopenia and agranulocytosis.
- Postpartum patients are a vulnerable group requiring careful monitoring during antibiotic treatment.
- Agranulocytosis, a severe reduction in granulocytes, necessitates prompt diagnosis and management.
Purpose of the Study:
- To report a case of agranulocytosis in a postpartum patient following extended antibiotic therapy.
- To emphasize the importance of vigilant hematologic monitoring during prolonged antimicrobial treatment.
- To highlight the role of granulocyte-colony stimulating factor (G-CSF) in managing antibiotic-induced agranulocytosis.
Main Methods:
- Case report of a 31-year-old puerperal woman.
- Detailed description of antibiotic treatment escalation and patient's clinical course.
- Hematological monitoring, bone marrow assessment, and response to G-CSF therapy.
Main Results:
- The patient developed agranulocytosis during extended antibiotic treatment for a presumed multidrug-resistant infection.
- Leukocyte count reached a nadir of 1.61 × 10^9/L despite initial improvements in infection markers.
- G-CSF therapy led to successful hematological recovery, and the patient was discharged with normal counts.
Conclusions:
- This case underscores the potential for severe hematological complications with prolonged antibiotic use.
- Rational antibiotic selection and precise diagnosis are critical to minimize adverse effects.
- Timely hematologic assessment and intervention, including G-CSF, are essential for managing agranulocytosis.
Abstract:
Antibiotic therapy is essential for managing bacterial infections, but rare yet serious hematological complications such as leukopenia and agranulocytosis may occur. These conditions, although uncommon, require timely diagnosis and intervention, particularly in vulnerable populations such as postpartum patients. This case report describes a 31-year-old puerperal woman who developed agranulocytosis after extended antibiotic treatment for a presumed multidrug-resistant infection. Initially treated with ceftriaxone and metronidazole, her therapy was later escalated to include ciprofloxacin, amoxicillin-clavulanic acid, and vancomycin. Enterococcus spp. and Staphylococcus aureus were isolated from multiple sites, although no systemic infection was confirmed. Bone marrow findings were consistent with agranulocytosis in the recovery phase. Despite improvements in infection markers, her leukocyte count progressively declined, reaching a nadir of 1.61 × 109/L on the 19th day of therapy. Granulocyte-colony stimulating factor (G-CSF) therapy was initiated, resulting in hematological recovery. The patient was discharged with normal inflammatory markers and leukocyte counts. This case highlights the importance of diagnostic precision, rational antibiotic use, and timely hematologic assessment during prolonged antimicrobial treatment.
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