High-Dose Benzylpenicillin Treatment Induced Febrile Neutropenia in HIV-Infected Male with Neurosyphilis: Case Report

Background: Prevention of an irreversible sequalae of neurosyphilis patients requires an immediate high-dosage of intravenous benzylpenicillin administered for prolonged periods of time. However, life-threatening neutropenia has been reported as one of the complications following the extended usage of benzylpenicillin. Case presentation: We report a 54-year-old HIV infected male patient, who developed a high-dose benzylpenicillin induced febrile neutropenia during the neurosyphilis treatment. The patient developed fever of up to 39.8°C, severe leukopenia (< 1x109/L), and neutropenia (0.2x109/L). He also presented with slightly elevated C-reactive protein and procalcitonin but had no clear symptoms of infection. The diagnosis was confirmed by excluding other possible causes of neutropenia: flu, measles, sepsis, and HIV-related neutropenia. The 3rd generation antipseudomonal cephalosporin in combination with vancomycin and granulocyte colony-stimulating factor were administered, and the patient saw a rapid improvement in clinical symptoms and laboratory findings. Conclusions: High-dose benzylpenicillin induced neutropenia should be considered as a complication after prolonged periods of neurosyphilis treatment with high-dose benzylpenicillin, when there is no evidence of other potential causes of neutropenia. Early diagnosis and proper treatment are critical in order to prevent this dangerous condition from deteriorating further.