Abstract

Case Report

Post-operative agranulocytosis caused by intravenous cefazolin: A case report with a discussion of the pathogenesis

Charles M Lombard*, Jiali Li and Bijayee Shrestha

Published: 18 February, 2022 | Volume 6 - Issue 1 | Pages: 009-012

A case of post-operative agranulocytosis which occurred in a 66-year-old woman following surgery for endometrial carcinoma is reported. The agranulocytosis had a rapid onset, being detected on the first post-operative day. The causative agent, cefazolin was given to the patient intraoperatively. The agranulocytosis persisted until the 22nd postoperative day. A bone marrow biopsy performed on post-operative day four showed a left-shifted myeloid maturation pattern but not a maturation arrest. The pathogenesis of drug-induced neutropenia/agranulocytosis is discussed. It is postulated that reversible binding of cefazolin to albumin accounts for the prolonged duration of agranulocytosis.

Read Full Article HTML DOI: 10.29328/journal.apcr.1001030 Cite this Article Read Full Article PDF

Keywords:

Agranulocytosis; Neutropenia; Postoperative; Cephalosporin; Cephazolin; Pathogenesis

References

  1. Andersohn F, Konzen C, Garbe E. Systemic review: Agranulocytosis induced by nonchemotherapy drugs. Ann Internal Med 2007; 146: 657-665. PubMed: https://pubmed.ncbi.nlm.nih.gov/17470834/
  2. Uetrecht J, Naisbitz DJ. Idiosyncratic adverse drug reactions: Current Pharmacol Rev. 2013; 65: 779-808. PubMed: https://pubmed.ncbi.nlm.nih.gov/23476052/
  3. Curtis BR. Non-chemotherapy drugs-induced neutropenia: Key points to manage the challenges. Hematology Am Soc Hematol Educ Program. 2017; 2017: 187-193. PubMed: https://pubmed.ncbi.nlm.nih.gov/29222255/
  4. Rattay B, Benndorf RA. Drug-induced idiosyncratic agranulocytosis-infrequent but dangerous. Fronti Pharmacol. 2021; 12: 1-13. PubMed: https://pubmed.ncbi.nlm.nih.gov/34483939/
  5. Smith CR. Cefotaxime and cephalosporins: Adverse reactions in Rev Infect Dis. 1982; 4: S481-S487. PubMed: https://pubmed.ncbi.nlm.nih.gov/6294802/
  6. Murphy MF, Metcalfe P, Grint PCA, et al. Cephalosporin-induced immune neutropenia. Br J Haem. 1985; 59: 9-14. PubMed: https://pubmed.ncbi.nlm.nih.gov/3882133/
  7. Cimino C, Allos BM, Phillips EJ. A review of beta-lactam-associated neutropenia and implications for cross-reactivity. Ann Pharm. 2021; 55: 1037-1049. PubMed: https://pubmed.ncbi.nlm.nih.gov/33215507/
  8. Murphy MF, Riordan T, Minchinton RM, et al. Demonstration of an immune- mediated mechanism of penicillin-induced neutropenia and Br J Haem. 1982; 55: 155-160. PubMed: https://pubmed.ncbi.nlm.nih.gov/6882683/
  9. Uy N, Thiagarajan P, Musher DM. Cephalosporin site chain idiosyncracies: A case report of ceftriaxone-induced agranulocytosis and review of literature. Open Forum Infect Dis. 2015; 2: ofv007. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4438888/
  10. Moeschlin S, Wagner K. Agranulocytosis due to the occurrence of leukocyte- agglutinins. Acta Haem. 1952; 8: 29-41. PubMed: https://pubmed.ncbi.nlm.nih.gov/12985212/
  11. Decroix MO, Zini R, Chaumeil JC, Tillement JP. Cefazolin serum protein binding and its inhibition by bilirubin, fatty acids and other drugs. Biochem Pharm. 1988; 37: 2807-2813. PubMed: https://pubmed.ncbi.nlm.nih.gov/3395358/
  12. Vella-Brincat JWA, Begg EJ, Kirkpatrick CMJ, Zhang M, Chambers ST, et al. Protein binding of cefazolin is saturable in vivo both between and within patients. Br J Cin Pharm. 2007; 63: 753-757. PubMed: https://pubmed.ncbi.nlm.nih.gov/17223858/
  13. Zorzi A, Linciano S, Angelini A. Non-covalently albumin-binding ligands for extending the circulating half-life of small biotherapeutics. Med Chem Commun. 2019; 10: 1068-1081. PubMed: https://pubmed.ncbi.nlm.nih.gov/31391879/
  14. Getta B, Ponnian G, Ling S. Intravenous immunoglobulin induces short-term reversal of drug-induced autoimmune neutropenia." Letter to editor. Transfus Med. 2015; 25: 347-348. PubMed: https://pubmed.ncbi.nlm.nih.gov/26192766/
  15. Jacob S, Rajabally YA. Currant proposed mechanisms of action of intravenous immunoglobulins in inflammatory neuropathies. Curr Neuropharmacol. 2009; 7: 337-342. PubMed: https://pubmed.ncbi.nlm.nih.gov/20514213/
  16. Norris PAA, Kaur G, Lazarus AH. New insight into intravenous immunoglobulin mechanisms and alternatives in autoimmune and inflammatory diseases. Curr Opin Hematol. 2020; 27: 392-398. PubMed: https://pubmed.ncbi.nlm.nih.gov/32868670/

Figures:

Similar Articles

Recently Viewed

  • Response of Chemical Fertilisation on Six-year-old Oil Palm Production in Shambillo-Padre Abad- Ucayali
    Efraín David Esteban Nolberto, Guillermo Gomer Cotrina Cabello*, Robert Rafael-Rutte, Jorge Luis Bringas Salvador, Mag. Carmen Luisa Aquije Dapozzo, Guillermo Vilchez Ochoa, Luis Alfredo Zúñiga Fiestas, Nancy Ochoa Sotomayor and Mg. Merici Medina Guerre Efraín David Esteban Nolberto, Guillermo Gomer Cotrina Cabello*, Robert Rafael-Rutte, Jorge Luis Bringas Salvador, Mag. Carmen Luisa Aquije Dapozzo, Guillermo Vilchez Ochoa, Luis Alfredo Zúñiga Fiestas, Nancy Ochoa Sotomayor, Mg. Merici Medina Guerre. Response of Chemical Fertilisation on Six-year-old Oil Palm Production in Shambillo-Padre Abad- Ucayali. Arch Food Nutr Sci. 2024: doi: 10.29328/journal.afns.1001058; 8: 024-028
  • Physiotherapy Undergraduate Students’ Perception About Clinical Education; A Qualitative Study
    Bimika Khadgi and Pravakar Timalsina* Bimika Khadgi,Pravakar Timalsina*. Physiotherapy Undergraduate Students’ Perception About Clinical Education; A Qualitative Study. J Nov Physiother Rehabil. 2024: doi: 10.29328/journal.jnpr.1001063; 8: 043-052
  • Current Practices for Severe Alpha-1 Antitrypsin Deficiency Associated COPD and Emphysema
    MJ Nicholson* and M Seigo MJ Nicholson*, M Seigo. Current Practices for Severe Alpha-1 Antitrypsin Deficiency Associated COPD and Emphysema. J Pulmonol Respir Res. 2024: doi: 10.29328/journal.jprr.1001058; 8: 044-047
  • Responding to disasters: about the governance of post-nuclear accident situations
    Jacques Lochard* Jacques Lochard*. Responding to disasters: about the governance of post-nuclear accident situations. Arch Psychiatr Ment Health. 2023: doi: 10.29328/journal.apmh.1001045; 7: 001-003
  • Forensic Psychology and Criminal Profiling
    Eze SM*, Alabi KJ, Yusuf AO, Hamzat FO, A Abdulrauf, Atoyebi AT, Lawal IA, OA Ibrahim, AY Imam-Fulani and Dare BJ Eze SM*,Alabi KJ,Yusuf AO,Hamzat FO,A Abdulrauf,Atoyebi AT,Lawal IA,OA Ibrahim,AY Imam-Fulani,Dare BJ. Forensic Psychology and Criminal Profiling. J Forensic Sci Res. 2025: doi: 10.29328/journal.jfsr.1001085; 9: 092-096

Read More

Most Viewed

Read More

Help ?