van den Broek Leonie, van der Werff-Ten Bosch Jutte, Cortoos Pieter-Jan, van Steijn Susanne, van den Akker Machiel
Department of Pediatrics, Queen Paola Children's Hospital, Antwerp, Belgium,
Department of Pediatric Hematology Oncology, UZ Brussel, Brussels, Belgium,
Int Med Case Rep J. 2018 Nov 15;11:333-337. doi: 10.2147/IMCRJ.S173826. eCollection 2018.
Neonatal neutropenia is regularly seen with variable etiology. We describe a breastfed infant with maternal medication use as a probable cause of neonatal neutropenia. An 8 days old exclusively breastfed female infant of Arab-Berber descent was referred to our hospital because of an infection of the umbilicus. Complete blood count showed a picture of severe isolated neutropenia. After initiating intravenous antibiotic treatment, the infection quickly resolved, but the isolated neutropenia persisted. Bone marrow aspiration indicated severe congenital neutropenia. The mother was known to have Crohn's disease, treated with methylprednisolone and adalimumab up to 3 months before delivery, and latent tuberculosis, for which she used isoniazid postnatally. Breast-feeding was terminated and filgrastim was started, with an increase of the neutrophilic count. After several weeks, filgrastim could be terminated. Bone marrow and complete blood count were repeated and were completely normal. This case report describes a very young breastfed female infant with severe neutropenia, causing an infection, in which maternal adalimumab use could not be excluded as a possible cause. Maternal isoniazid use is highly unlikely.
新生儿中性粒细胞减少症病因多样，较为常见。我们描述了一例母乳喂养的婴儿，其母亲用药可能是导致新生儿中性粒细胞减少症的原因。一名8天大、纯母乳喂养的阿拉伯 - 柏柏尔裔女婴因脐部感染被转诊至我院。全血细胞计数显示为严重的单纯性中性粒细胞减少症。开始静脉用抗生素治疗后，感染迅速消退，但单纯性中性粒细胞减少症持续存在。骨髓穿刺提示严重先天性中性粒细胞减少症。已知母亲患有克罗恩病，在分娩前3个月一直使用甲泼尼龙和阿达木单抗治疗，且患有潜伏性结核病，产后使用异烟肼治疗。停止母乳喂养并开始使用非格司亭后，中性粒细胞计数增加。几周后，非格司亭可以停用。重复进行骨髓检查和全血细胞计数，结果完全正常。本病例报告描述了一名非常年幼的母乳喂养女婴患有严重中性粒细胞减少症并引发感染，其中不能排除母亲使用阿达木单抗作为可能病因，而母亲使用异烟肼极不可能是病因。
