AGRANULOCYTOSIS CAUSED BY INFECTIOUS-TOXI C BONE-MARROW DAMAGE AFTER LYME BORRELIOSIS

A 19-year-old girl developed a fever of up to 40 degrees C and, during an episode of high fever, generalized seizures. Physical examination on admission was unremarkable, except for several small lymph nodes. D ifferential blood count showed a leukopenia (1700/mu l) with 14% stab and 7% segmented neutrophils. After initial clinical improvement she a gain became feverish and the differential count now showed agranulocyt osis with a total white cell count of 1400/mu l. Because of the time o f year and the geographic location borreliosis was now considered in t he differential diagnosis. The antibody titre against Borrelia was rai sed to 1:64 (IgM) and 1:256 (IgG). Her condition and the differential blood count rapidly improved on intravenous antibiotic treatment with cefotiam (2 g two times daily) and gentamicin (120 mg two times daily) , as well as filgrastim (granulocyte-colony stimulating factor) subcut aneously, Antibiotic treatment was continued after 6 days with oral am picillin (1 g three times daily) for 3 weeks. Follow-up examination si x weeks later found the patient to be symptom-free.