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Case report
Austrian syndrome, ceftriaxone-induced agranulocytosis and COVID-19
  1. James Edward McCulloch1,
  2. Alexandra Miller1,
  3. Marius Borcea2 and
  4. Jeremy Reid3
  1. 1Intensive Care, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK
  2. 2Intensive Care Medicine, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK
  3. 3Anaesthesia, Yeovil District Hospital, Yeovil, UK
  1. Correspondence to Dr James Edward McCulloch; james_mcculloch{at}hotmail.com

Abstract

We present a case of a 75-year-old woman with Austrian syndrome: pneumonia, meningitis and endocarditis all due to Streptococcus pneumoniae. Transoesophageal echocardiogram demonstrated a large mitral valve vegetation with severe mitral regurgitation. She was treated with intravenous ceftriaxone and listed for surgical repair of her mitral valve. Preoperatively, she developed an idiosyncratic drug-induced agranulocytosis secondary to ceftriaxone, which resolved on cessation of the medication. However, while awaiting neutrophil recovery, she developed an acute deterioration, becoming critically unwell. This deterioration was multifactorial, with acute decompensated heart failure alongside COVID-19. After multidisciplinary discussion, she was considered too unwell for surgery and palliated.

  • meningitis
  • pneumonia (infectious disease)
  • unwanted effects / adverse reactions
  • cardiothoracic surgery
  • adult intensive care

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/bcr-2020-239355

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    Footnotes

    • Contributors JEMC is the main editor and wrote the background and discussion. AM wrote the clinical presentation and treatment. MB and JR are editors

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Next of kin consent obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.