Cefuroxime induced agranulocytosis during heart transplant period: A case report

Abstract

Rationale: Cefuroxime is a commonly prescribed antibiotic known for its overall safety profile. However, in rare instances, it can lead to a life-threatening condition known as idiosyncratic drug-induced agranulocytosis (IDIA). While there have been few documented cases linking cefuroxime to this severe adverse reaction, a recent study sheds light on a critical case involving a patient awaiting a heart transplant. Patient concern: In this study, the patient developed agranulocytosis after 16 days and 72 grams of cefuroxime treatment. Agranulocytosis is characterized by a drastic reduction in neutrophil count, in this case dropping to 0/mm3. Diagnosis: IDIA is characterized by a drastic reduction in neutrophil count, in this case dropping to 0/mm3. Intervention: This IDIA coincided with the availability of a donor heart, prompting the medical team to proceed with an immediate heart transplant despite the patient’s compromised immune status. Ceasing cefuroxime administration and initiating treatment with G-CSF for 3 days played a pivotal role in normalizing neutrophil levels. A meticulously planned immunosuppressant regimen was also initiated. Outcomes: Precise management of immunosuppressants contributed to the patient’s successful recovery, leading to discharge. Lessons: The rationale for studying cases like these lies in the need for heightened awareness among healthcare providers. By documenting and analyzing such cases, medical professionals can better understand the risk factors, clinical presentation, and optimal management strategies for this uncommon yet serious adverse reaction. Furthermore, the study underscores the significance of individualized patient care, especially in complex scenarios such as organ transplantation. Precise adjustments to immunosuppressant therapy are crucial to balance the risks of rejection and infection, particularly in patients with compromised immune systems due to drug-induced agranulocytosis. In conclusion, this case serves as a reminder of the unpredictable nature of drug reactions and the importance of vigilant monitoring and rapid intervention in managing potentially life-threatening complications.