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Leukopenia and neutropenia: case report A 24-year-old woman developed leukopenia and neutropenia during treatment with rifabutin and azithromycin for Mycobacterium lentiflavum infection [not all outcomes stated]. The woman, who had a history of Bartter syndrome, oesophagitis, gastroparesis, was admitted due to transaminitis with granulomatous disease and was subsequently diagnosed with Mycobacterium lentiflavum infection. Based on sensitivity testing, the isolate was found to be multidrug resistant and then she was discharged with a scheduled treatment plan. A month later, she was rehospitalised to receive her scheduled antimycobacterial therapy. She was started rifabutin 300mg daily and azithromycin 250mg daily on day 1 along with amikacin and clofazimine. On day 5 after the initiation of antimycobacterial therapy, the WBC count started to decrease (leukopenia). By day 13, WBC count had decreased to 1600 cells/µL with absolute neutrophil count of 610 cells/µL (neutropenia). Both leukopenia and neutropenia were considered to be related to rifabutin with a possible contribution of azithromycin. Therefore, the woman’s rifabutin was discontinued. Following cessation of rifabutin (on day 17), WBC count improved. She was then started on rifampin, following which WBC count continued to improve and remained stable for 8 months of the therapy. Author comment: "This report describes a case of successful rifampin challenge after possible rifabutin induced leukopenia and neutropenia." "This case resulted with a "possible" association between rifabutin and leukopenia on the Naranjo scale . . . although there were possible alternative explanations, including other antimycobacterial medications such as azithromycin (–1)." Britt RS, et al. Successful Rifampin Administration After Rifabutin-Induced Leukopenia. Annals of Pharmacotherapy 54: 82-83, No. 1, 1 Jan 2020. Available 803444276 from: URL: http://doi.org/10.1177/1060028019867971 - USA

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Reactions 4 Jan 2020 No. 1785