Granulocyte Crisis during Tuberculosis Treatment: A Case of First-line Antituberculosis Treatment-induced Agranulocytosis

Agranulocytosis is a rare but life-threatening complication of first-line antituberculosis therapy (ATT). We report this case of 66-year-old female with extrapulmonary lymph node tuberculosis and past history of sarcoidosis and papillary thyroid carcinoma, who developed severe neutropenia during ATT. The patient presented with high-grade fever, cough, difficulty in eating, and dyspnea for 2 days and was admitted for the management of a suspected respiratory infection. While on a modified ATT for 6 weeks, she developed severe neutropenia (absolute neutrophil count of 9 cells/μL out of 930 total white blood cells). Granulocyte colony-stimulating factor was initiated, leading to hematological recovery. ATT was reintroduced in a step-by-step manner, and the patient achieved clinical stability. This case highlights a rare case of hematological toxicity on ATT.