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Neutropenia, renal dysfunction and liver dysfunction: case report A 72-year-old man developed neutropenia, renal dysfunction and liver dysfunction during treatment with ampicillin, meropenem or vancomycin for ventriculitis. The man was admitted due to arch aneurysm with acute aortic dissection (thrombosed Stanford type A) and received unspecified anti-impulsive therapy. Subsequently, an emergent total arch replacement under cardiopulmonary bypass (CPB) was performed and he was started on heparin as anticoagulant therapy. During surgery, a severe adhesion between the adventitia of the descending aorta and the pleura was detected. Hence, an antegrade selective cerebral perfusion (SCP) was performed to protect brain. The circulatory arrest time was 57 minutes, aortic cross clamp time was 118 minutes and CPB time was 241 minutes. After the surgery, his haemodynamics were stable, and despite discontinuation of sedative drugs, he remained in coma from postoperative day (POD) 1 to POD 2. CT scan of the brain performed on POD-2 showed no brain infarction or intracranial bleeding. MRI (diffusion‐weighted imaging) of the brain was indicative of ventriculitis. CSF analysis revealed increased total cell count and low glucose. However, both blood culture and CSF gram stain performed on POD-3, POD-17, POD-27 and POD-39 showed no organism. He was started on daily injections of vancomycin 1.5g, meropenem 6g and ampicillin 12g along with daily dexamethasone injection [routes not stated]. Meropenem was administered for 34 days, and then was switched to cephalosporin due to meropenem-related neutropenia. Cephalosporin was administered for 6 days, which was changed to doripenem due recurrence of fever. Vancomycin was administered for 16 days, and the discontinued due to vancomycin-related renal dysfunction. He received ampicillin for 8 days, but due to liver dysfunction as its side effect, ampicillin was also discontinued. After improvement in CSF analysis results and MRI findings, doripenem treatment was stopped on POD-47. His Glasgow Coma Scale score improved on POD 9, following which he was weaned off of ventilation. His ICU stay was of 16 days. On POD 58, he was transferred to a rehabilitation facility [time to reactions onset and outcomes not stated]. Sasaki H, et al. Ventriculitis after emergent arch aneurysm surgery. Journal of Cardiac Surgery 35: 2382-2384, No. 9, Sep 2020. Available from: URL: http://doi.org/10.1111/ 803507841 jocs.14720

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Reactions 17 Oct 2020 No. 1826