cefoxitin and Leukopenia

The idiopathic Tn-syndrome, formerly called 'permanent mixed-field polyagglutinability', is a rare hematological disorder characterized by the expression of the Tn-antigen on all blood cell lineages. The immunodominant epitope of the Tn-antigen is terminal alpha-N-acetylgalactosamine, O-glycosidically linked to protein. Normally this residue is 3'-substituted by 5-galactose thereby forming the core 1 structure known as the Thomsen-Friedenreich (TF) antigen (Galbeta1 ==> 3GalNAcalpha1 ==> Thr/Ser). The cause of the exposure of the Tn-antigen appears to be due to the silencing of the gene expression of beta1,3galactosyltransferase, since treatment of deficient Tn(+) lymphocyte T clones with 5'azacytidine or Na butyrate leads to reexpression of enzyme activity and the sialylated TF-antigen. The Tn-syndrome is acquired and permanent and affects both sexes at any age. Its origin is unknown. Pluripotent stem cells are affected since all lineages are involved but each one to a variable extent. Therefore, normal cells co-exist with Tn-transformed cells. Clinically, patients suffering from the Tn-syndrome appear healthy. Laboratory findings usually reveal moderate thrombocyto- and leukopenia and some signs of hemolytic anemia not warranting any treatment.

Topics: Anemia, Hemolytic; Antibodies, Monoclonal; Antigens, Neoplasm; Antigens, Tumor-Associated, Carbohydrate; Azacitidine; Blood Cells; Erythrocyte Membrane; Galactosyltransferases; Hematologic Diseases; Humans; Lectins; Leukopenia; Molecular Structure; Syndrome; Thrombocytopenia

To describe a case of cefazolin-induced leukopenia in a critically ill patient who developed this adverse reaction upon rechallenge with cefoxitin.. A 22-year-old male was admitted after a motor vehicle crash. beta-Lactam therapy was initiated with vancomycin, cefepime, and metronidazole and, upon identification of methicillin-sensitive Staphylococcus aureus bacteremia 4 days later, therapy was narrowed to cefazolin 1 g every 12 hours. The dose was adjusted to 1 g every 12 hours during continuous venovenous hemodialysis. Imipenem was given for 2 days, resulting in a total of 18 days of beta-lactam treatment, at which time he developed significant leukopenia (white blood cell [WBC] count 0.9 x 10(3)/microL). Antimicrobial treatment was changed to tigecycline and continued for suspected pleural space infection. The patient's WBC count recovered within 4 days after the change in therapy. He was taken to surgery 8 days after cefazolin was discontinued and received perioperative prophylaxis with cefoxitin (total dose 3 g). Subsequently, the patient again became severely leukopenic (WBC count 2.4 x 10(3)/microL). Within a week after surgery, the patient developed septic shock secondary to multidrug-resistant Escherichia coli bacteremia and died.. beta-Lactam-induced leukopenia is a rare but well-described adverse drug reaction. It is a cumulative dose-dependent phenomenon reported to occur most often after 2 weeks of therapy. The mechanism of leukopenia is thought to be secondary to either an immune-mediated response or direct bone marrow toxicity. Rechallenge with a different beta-lactam antibiotic has not been shown to consistently cause recurrent leukopenia. The case described here suggests an immune-related mechanism for the development of leukopenia. Use of the Naranjo probability scale determined the association between cephalosporin use and leukopenia to be probable.. Cefazolin was a probable cause of this patient's leukopenia. It is important for clinicians to recognize beta-lactam-induced leukopenia and maybe recommend use of a drug from a different antibiotic class if continued treatment is indicated.

Topics: Adult; Anti-Bacterial Agents; Bacterial Infections; Cefoxitin; Humans; Leukocyte Count; Leukopenia; Male

The effects of cefotetan, cefoxitin, cefazolin, and cefotaxime on polymorphonuclear leukocyte chemotaxis and chemiluminescence were determined in 10 patients with pelvic inflammatory disease and 10 oncologically treated patients. It was found that cefotetan enhanced both chemotaxis and chemiluminescence, with the favorable effects more pronounced in the oncologically treated patients with leukopenia. Cefotaxime depressed polymorphonuclear leukocyte functions. Cefoxitin and cefazolin had no significant effects. It would be logical, when treating empirically, to choose a regimen that enhances and not depresses host defenses in all patients but more expressly in leukopenic and other immunologically compromised patients.

Topics: Cefazolin; Cefotaxime; Cefotetan; Cefoxitin; Cephalosporins; Cephamycins; Chemotaxis, Leukocyte; Female; Humans; Leukopenia; Neutrophils; Pelvic Inflammatory Disease

Two cases of penicillin-induced and one case of cephalosporin-induced leucopenia are described. This unusual complication of widely used beta-lactam antibiotics can occur when these antibiotics are administered parenterally in high doses for prolonged periods (14 days or more). The close monitoring of the white cell count is important when treating patients with high doses of beta-lactam antibiotics for prolonged periods. We would like to emphasize that when penicillin- or cephalosporin-induced leucopenia is suspected, continuation with another beta-lactam antibiotic may be dangerous.

Topics: Adult; Cefoxitin; Humans; Leukopenia; Male; Middle Aged; Penicillin G

Topics: Acute Disease; Aged; Cefoxitin; Female; Humans; Leukopenia