Moxifloxacin-Associated Neutropenia in a Cirrhotic Elderly Woman with Lower Extremity Cellulitis

Moxifloxacin-Associated Neutropenia in a Cirrhotic Elderly Woman with Lower Extremity Cellulitis

Ann Pharmacother. 2008 Mar

Chang CM, Lee NY, Lee HC, Lee IW, Wu CJ, Lin YS, Ko WC.
Divisions of Infectious Diseases, Geriatrics, and Gerontology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.

OBJECTIVE: To report a case of moxifloxacin-associated neutropenia in a cirrhotic patient with cellulitis.

CASE SUMMARY: A 77-year-old cirrhotic woman developed cellulitis of the right leg, with a nadir white blood cell (WBC) count of 1.5 x 103/microL and absolute neutrophil count (ANC) of 0.345 x 103/microL, which occurred after 5 days of moxifloxacin therapy. Moxifloxacin was switched to cefixime and neutropenia resolved 2 days after the withdrawal of moxifloxacin.

DISCUSSION: Cases of neutropenia related to fluoroquinolones have rarely been reported in the literature, and neutropenia associated with moxifloxacin has not been described before. Because of the temporal relationship between moxifloxacin administration and the development of neutropenia in our patient, as well as the relationship between drug withdrawal and improvement in WBC count and ANC, moxifloxacin-associated neutropenia was suspected. This reaction was categorized as probable according to the Naranjo probability scale.

CONCLUSIONS: We report the first case of moxifloxacin-associated neutropenia. Although such an adverse reaction is rare, clinicians should be aware of this potential complication of moxifloxacin therapy.

Annals of Pharmacotherapy

Incidence of lower-extremity cellulitis: a population-based study in olmsted county, Minnesota.

Incidence of lower-extremity cellulitis: a population-based study in olmsted county, Minnesota.
Mayo Clin Proc. 2007 Jul

McNamara DR, Tleyjeh IM, Berbari EF, Lahr BD, Martinez JW, Mirzoyev SA, Baddour LM.
Division of Infectious Diseases, MeritCare Health System, PO Box MC, Fargo, ND 58122 (e-mail: mcnamara.david@mayo.edu).

OBJECTIVE: To determine the population-based incidence of lower-extremity cellulitis.

METHODS: We performed a population-based survey with the resources of the Rochester Epidemiology Project in Olmsted County, Minnesota. We identified residents of Olmsted County who sought care for cellulitis from January 1, 1999, through December 31, 1999, reviewed medical records to ascertain agreement with a case definition of lower-extremity cellulitis, and calculated the population-based incidence of lower-extremity cellulitis.

RESULTS: During 1999, 176 episodes met the case definition of lower-extremity cellulitis; the incidence of lower-extremity cellulitis in Olmsted County was 199 per 100,000 person-years. Sex-specific incidence was 197 per 100,000 person-years for women and 201 per 100,000 person-years for men. In a sex-adjusted model, the incidence increased 3.7% (95% confidence interval, 2.9%-4.5%) per year increment in age or 43.8% (95% confidence interval, 33.6%-54.7%) per 10-year increment. The incidence of cellulitis significantly increased with age (P less than .001 in Poisson regression) but was not statistically significantly different between the sexes.

CONCLUSIONS: The incidence of lower-extremity cellulitis in this population-based study was high and was affected by age. In contrast, sex did not influence infection incidence. The need for hospitalization and the prevalence of recurrence of lower-extremity cellulitis added to the burden of disease in Olmsted County.

Mayo Clinic