A 49-year-old woman was admitted for treatment of gingival carcinoma of the mandible. Tumor resection of the right side of the mandible,partial resection of the right side of the maxilla,right functional neck dissection,and reconstruction using a left fibulo-cutaneous free flap were performed.Infections due to methicillin-resistant strains of Staphylococcus aureus(MRSA)developed 7 days later.Administration of vancomycin(VCM)was effective in controlling the infections, but caused neutropenia.

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... rteen days after operation,neutrophils became undetectable.Twenty-four-hour continuous intravenous infusion of granulocyte colony stimulating factor(G-CSF)was effective against agranulocytosis.The stimulation index of VCM on drug lymphocyte stimulating tests(DLST)was 713(normal <180),demonstrating that VCM had caused the agranulocytosis.