Karisik Edin, Stanojevic-Ristic Zorica, Jevtic Marija, Rasic Julijana, Maric Miljana, Popovic Milica
Department of Internal Medicine, General Hospital Novi Pazar, 36300 Novi Pazar, Serbia.
Department of Pharmacology and Toxicology, Faculty of Medicine, University of Pristina, 38220 Kosovska Mitrovica, Serbia.
Hematol Rep. 2025 Jun 12;17(3):30. doi: 10.3390/hematolrep17030030.
Cephalosporins are considered safe antibiotics. However, serious hematological abnormalities may occur, although rarely, after their therapeutic use. We present a case of pancytopenia in a 72-year-old female patient treated with ceftriaxone for a urinary tract infection. After five days of therapy, pancytopenia was observed. Other causes were excluded through extensive diagnostic evaluation, including immunological tests, viral serologies, bone marrow aspiration, and peripheral blood smear. The patient's clinical condition significantly improved following the discontinuation of ceftriaxone and the administration of granulocyte colony-stimulating factor (G-CSF). Bone marrow findings revealed hypocellularity without malignant infiltration, and peripheral smear showed no dysplasia, blasts, or hemolysis. This case demonstrates that ceftriaxone, although widely regarded as a safe antibiotic, can induce rare but serious hematologic complications such as pancytopenia. A high index of suspicion is required when patients on antibiotic therapy develop unexplained cytopenias. Detailed medication history, exclusion of other causes, and prompt discontinuation of the suspected drug are essential. The patient's favorable outcome supports the likelihood of an idiosyncratic, immune-mediated mechanism. Future research should explore pharmacogenomic screening in patients at increased risk, particularly involving HLA variants.
头孢菌素被认为是安全的抗生素。然而，在其治疗使用后，尽管很少见，但可能会出现严重的血液学异常。我们报告一例72岁女性患者，因尿路感染接受头孢曲松治疗后出现全血细胞减少。治疗五天后，观察到全血细胞减少。通过广泛的诊断评估排除了其他病因，包括免疫检查、病毒血清学、骨髓穿刺和外周血涂片。停用头孢曲松并给予粒细胞集落刺激因子（G-CSF）后，患者的临床状况显著改善。骨髓检查结果显示细胞减少，无恶性浸润，外周血涂片未显示发育异常、原始细胞或溶血。该病例表明，头孢曲松虽然被广泛认为是一种安全的抗生素，但可诱发罕见但严重的血液学并发症，如全血细胞减少。当接受抗生素治疗的患者出现无法解释的血细胞减少时，需要高度怀疑。详细的用药史、排除其他病因以及及时停用可疑药物至关重要。患者的良好预后支持了特异质性、免疫介导机制的可能性。未来的研究应探索对高危患者进行药物基因组筛查，特别是涉及HLA变异体。
