A 22-year-old woman is brought to the emergency department because of a 2-day history of fever, intermittent rigors, and night sweats. She also has a 1-month history of progressive fatigue. Five weeks ago, she was hospitalized and received intravenous antibiotics for treatment of bacterial meningitis while visiting relatives in Guatemala. Her temperature is 39.4°C (102.9°F), pulse is 130/min, and blood pressure is 105/70 mm Hg. Examination shows pallor and scattered petechiae and ecchymoses. Laboratory studies show a hemoglobin concentration of 9.0 g/dL, a leukocyte count of 1100/mm3 with 30% segmented neutrophils, and a platelet count of 20,000/mm3. The patient was most likely treated with which of the following antibiotics?

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Quizplus · Accepted Answer

Eductional Objective: Pancytopenia due to bone marrow suppression is a side effect of therapy with chloramphenicol. It may develop in a dose-dependent, reversible manner or manifest as dose-independent irreversible aplastic anemia with a sudden onset up to several months after treatment. Aplastic anemia is a rare but potentially fatal side effect, so the use of chloramphenicol has been limited in resource-rich countries. However, due to its low cost, it is often still used to treat bacterial meningitis caused by H. influenza, N. meningitidis, or S. pneumoniae in resource-limited countries.

A 22-Year-Old Woman Is Brought to the Emergency Department Because