Vancomycin-Induced Neutropenia

Abstract

A case of vancomycin-induced neutropenia is presented with a review of other reported cases in the literature. A 59-year-old white female was started on vancomycin therapy for a chronic infection of a total left hip replacement. After 38 days of treatment, the patient developed a severe leukopenia with a white blood cell count of 1700/mm³ and the presence of only occasional neutrophils. Upon discontinuation of vancomycin, the leukocyte and neutrophil counts promptly increased with full recovery in one week. Subsequently, the patient was restarted on a five-day course of vancomycin at a lower dose that proved uneventful with no recurrence of neutropenia. It is unclear whether the neutropenia would have recurred with a longer course of vancomycin. A review of the literature suggests that an immunologic mechanism may be responsible for the reaction. Physicians and other health professionals should be aware that neutropenia is a potential reaction of patients receiving prolonged vancomycin treatment.