Fever, rash and agranulocytosis

Description

A Caucasian woman aged 74 years successfully underwent laminectomy and decompression surgery for spinal stenosis, which was complicated by wound infection with community-acquired methicillin-resistant Staphylococcus aureus (MRSA), MRSA bacteraemia and endocarditis. MRSA was resistant to clindamycin, erythromycin and oxacillin. The patient was started on intravenous ceftaroline 600 mg two times per day. Four weeks later, she presented to the emergency room with fever and rash for 1 week. Physical examination revealed diffuse erythematous rash involving the hands, thighs and legs (figure 1A, B). Laboratory investigations revealed WCC 1000/mm³ (normal range: 4000–11 000), absolute neutrophil count 0, haemoglobin 8.2 g/dL (normal range: 12–16 g/dL) and platelets 279 000/mm³ (normal range: 150 000–400 000/mm³). Peripheral blood smear confirmed agranulocytosis (figure 1C) without abnormal blood cells. Ceftaroline-induced reaction was suspected. Therefore, she was admitted to hospital and ceftaroline was immediately discontinued. The patient was started on vancomycin to complete her antibiotic course and filgrastim...

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