J Korean Med Sci.  2009 Oct;24(5):975-978. 10.3346/jkms.2009.24.5.975.

Antibiotic-induced Severe Neutropenia with Multidrug-Dependent Antineutrophil Antibodies Developed in A Child with Streptococcus pneumoniae Infection

• Lee YH
• Lee HB
• Kim JY
• Lim YJ
• Shin SA
• Han TH

• KMID: 1782027
• DOI: http://doi.org/10.3346/jkms.2009.24.5.975

Abstract

Drug-induced neutropenia (DIN), particularly that in which antibiotic-dependent antineutrophil antibodies have been detected, is a rare disorder. We report the case of a child with pneumococcal pneumonia, who experienced severe neutropenia during various antibiotic treatments. We detected 4 kinds (cefotaxim, augmentin, vancomycin, and tobramycin) of antibiotic-dependent antineutrophil antibodies by using the mixed passive hemagglutination assay (MPHA) technique with this child.

Keyword

Neutropenia; Antineutrophil Antibody; Anti-Bacterial Agents

MeSH Terms

Anti-Bacterial Agents/*therapeutic use
Antibodies, Antineutrophil Cytoplasmic/*blood/immunology
Autoantibodies/blood/immunology
Drug Therapy, Combination
Humans
Infant
Male
Neutropenia/chemically induced/*diagnosis
Pneumonia, Pneumococcal/complications/*drug therapy
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 The clinical course and changing pattern of absolute neutrophil counts according to antibiotic treatment. Aug, Augmentin; Tobra, Tobramycin; IVIG, intravenous immunoglobulin; G-CSF, granulocyte-colony stimulating factor; WBC, white blood cell count; ANC, absolute neutrophil count.

• 

  Fig. 2 The detection of granulocyte antibody in the patient's serum. The serum is reactive with the patient's granulocyte but not with all of the donors' granulocytes. Row A, patient's granulocyte coated well; Row B, donor 1 granulocyte; Row C, donor 2 granulocyte; Row D, donor 3 granulocyte; Column 1, positive control; Column 2, negative control; Column 3, patient's serum.

• 

  Fig. 3 The granulocyte antibody has specificity for antibiotics. The patient's granulocyte coated wells are used. The patient's serum is serially diluted to 1:256 and 5 µL of each drug (1 mg/mL) is added. The serum is 1:8 reactive without drugs and 1:64 reactive with cefotaxim, augmentin, vancomycin, and tobramycin, but 1:4 reactive with roxithromycin and aspirin. Row A, no drug; Row B, aspirin; Row C, roxithromycin; Row D, cefotaxim; Row E, augmentin; Row F, vancomycin; Row G tobramycin; Column 1, positive control; Column 2, negative control; Column 3, patient's serum; Column 4 patient's serum (1:2); Column 5 patient's serum (1:4); Column 6 patient's serum (1:8); Column 7 patient's serum (1:16); Column 8 patient's serum (1:32); Column 9 patient's serum (1:64); Column 10 patient's serum (1:128); Column 11 patient's serum (1:256).

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  Fig. 4 The patient's serum coincubated with the drug is reactive with none of the donor's granulocytes. The donors' granulocyte-coated wells are used. Row A, donor1; Row B, donor 2; Row C, donor 3; Row D, donor 4; Column 1, positive control; Column 2, negative control; Column 3, patient's serum only; Column 4, patient's serum and aspirin; Column 5 patient's serum and roxithromycin; Column 6, patient's serum and cefotaxim; Column 7, patient's serum and augmentin; Column 8, patient's serum and vancomycin; Column 9, patient's serum and tobramycin.

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