Korean J Nephrol.  2006 May;25(3):515-519.

Vancomycin-Induced Agranulocytosis and Rhinocerebral Mucormycosis in a Patient with Continuous Ambulatory Peritoneal Dialysis-Associated Peritonitis

• Kim SJ
• Park SY
• Song YS
• Park JW
• Oh JE

Abstract

Vancomycin-induced agranulocytosis is a rare side effect, but the increased use of vancomycin may disclose a more frequent occurrence. And it is a life-threatening complication, especially in end stage renal disease (ESRD) patients. We describe a 62-year-old patient with continuous ambulatory peritoneal dialysis (CAPD), who developed agranulocytosis after 3 weeks intraperitoneal administration of vancomycin for treatment of peritonitis caused by methicillin-resistant Staphylococcus haemolyticus. The agranulocytosis was resolved with granulocyte colony-stimulating factor (G-CSF) therapy and by the discontinuation of vancomycin. But, the patient developed subsequent rhinocerebral mucormycosis with invasion to skull base associated prolonged neutropenic period and expired in spite of surgical resection and intravenous administration of amphotericin. This case serves as a reminder to clinicians that patients receiving long-term treatment with vancomycin should have their white blood cell count monitored and vancomycin-induced agranulocytosis should be corrected promptly.

Keyword

Agranulocytosis; Vancomycin; Peritoneal Dialysis; Rhinocerebral mucormycosis

MeSH Terms

Administration, Intravenous
Agranulocytosis*
Amphotericin B
Granulocyte Colony-Stimulating Factor
Humans
Kidney Failure, Chronic
Leukocyte Count
Methicillin Resistance
Middle Aged
Mucormycosis*
Peritoneal Dialysis
Peritoneal Dialysis, Continuous Ambulatory
Peritonitis*
Skull Base
Staphylococcus haemolyticus
Vancomycin
Amphotericin B
Granulocyte Colony-Stimulating Factor
Vancomycin