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Leucopenia: case report A 22-year-old man developed leucopenia while receiving cefepime and cefazolin, and again while receiving cefoxitin. The man was hospitalised following a motor vehicle accident. His hospital course was complicated by numerous infections. He began receiving IV cefepime 2g every 12 hours and vancomycin on day 10 for suspected ventilator-associated pneumonia. Treatment continued for 6 days and his WBC count remained within the normal range. On day 21 of hospitalisation he developed septic shock, prompting reinitiation of cefepime 2g every 12 hours and vancomycin, with the addition of metronidazole. This treatment continued for 4 days, when it was replaced with cefazolin 1g every 12 hours, after the discovery of meticillin-sensitive Staphylococcus aureus in blood cultures. At this time he had a WBC count of 20.9 × 103/µL. Following an initial improvement, his pulmonary status significantly deteriorated and he developed renal failure secondary to septic shock, prompting initiation of continuous venovenous haemodialysis. On day 37 of hospitalisation cefazolin was discontinued, and his therapy was broadened with imipenem following the development of hypotension and hypothermia. At the time of cefazolin discontinuation he had a WBC count of 0.9 × 103/µL and absolute neutrophil count of 648 × 103/µL. On day 38, the man’s treatment was switched to tigecycline. His WBC count began to increase reaching a maximum of 8.5 × 103/µL. However, on day 46, he underwent laparotomy for bleeding of a jejunal ulcer and received antibiotic prophylaxis consisting of cefoxitin 1g immediately before the procedure, then 12 and 16 hours postoperatively. Five hours after the first cefoxitin dose his WBC count dropped to 2.4 × 103/µL. Cefoxitin was discontinued but his WBC count failed to recover. The man developed worsening sepsis 5 days after laparotomy and died. Whitman CB, et al. Cephalosporin-induced leukopenia following rechallenge with cefoxitin. Annals of Pharmacotherapy 42: 1327-1332, No. 9, Sep 2008 801099788 USA

» Editorial comment: "Our patient developed significant

leukopenia after 18 days of treatment with β-lactam antibiotics (16 days of which were with cephalosporins). . . Using the Naranjo probability scale, we determined a probable association between the use of cephalosporins and the development of leukopenia."

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Reactions 16 Aug 2008 No. 1215