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She was treated with intravenous ceftriaxone and listed for surgical repair of her mitral valve. Preoperatively, she developed an idiosyncratic drug-induced agranulocytosis secondary to ceftriaxone, which resolved on cessation of the medication. However, while awaiting neutrophil recovery, she developed an acute deterioration, becoming critically unwell. This deterioration was multifactorial, with acute decompensated heart failure alongside COVID-19. After multidisciplinary discussion, she was considered too unwell for surgery and palliated.<\/jats:p>","DOI":"10.1136\/bcr-2020-239355","type":"journal-article","created":{"date-parts":[[2021,1,6]],"date-time":"2021-01-06T13:47:44Z","timestamp":1609940864000},"page":"e239355","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Austrian syndrome, ceftriaxone-induced agranulocytosis and COVID-19"],"prefix":"10.1136","volume":"14","author":[{"given":"James Edward","family":"McCulloch","sequence":"first","affiliation":[{"name":"Intensive Care, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Miller","sequence":"additional","affiliation":[{"name":"Intensive Care, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marius","family":"Borcea","sequence":"additional","affiliation":[{"name":"Intensive Care Medicine, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy","family":"Reid","sequence":"additional","affiliation":[{"name":"Anaesthesia, Yeovil District Hospital, Yeovil, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,1,6]]},"reference":[{"key":"2025082711002488000_14.1.e239355.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(04)00938-7"},{"key":"2025082711002488000_14.1.e239355.2","first-page":"539","article-title":"Pneumococcal endocarditis, meningitis and rupture of the aortic valves","volume":"99","author":"Austrian","year":"1957","journal-title":"JAMA Internal Medicine"},{"key":"2025082711002488000_14.1.e239355.3","article-title":"Austrian Syndrome - A Devastating Osler's Triad: Case Report and Literature Review","volume":"11","author":"Rako\u010devi\u0107","year":"2019","journal-title":"Cureus"},{"key":"2025082711002488000_14.1.e239355.4","doi-asserted-by":"crossref","first-page":"e36","DOI":"10.1016\/j.ijcard.2007.01.085","article-title":"Austrian syndrome: a clinical rarity","volume":"127","author":"Velazquez","year":"2008","journal-title":"Int J Cardiol"},{"key":"2025082711002488000_14.1.e239355.5","doi-asserted-by":"publisher","DOI":"10.1097\/MOH.0b013e3282f15fb9"},{"key":"2025082711002488000_14.1.e239355.6","doi-asserted-by":"publisher","DOI":"10.7812\/TPP\/18-041"},{"key":"2025082711002488000_14.1.e239355.7","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofv007"},{"key":"2025082711002488000_14.1.e239355.8","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-019-05907-4"},{"key":"2025082711002488000_14.1.e239355.9","first-page":"41","article-title":"Prognosis of delirium in elderly hospital patients","volume":"149","author":"Cole","year":"1993","journal-title":"CMAJ"},{"key":"2025082711002488000_14.1.e239355.10","first-page":"25","article-title":"Have a high index of suspicion for meningitis in adults","volume":"260","author":"Gaillemin","year":"2016","journal-title":"Practitioner"},{"key":"2025082711002488000_14.1.e239355.11","doi-asserted-by":"publisher","DOI":"10.1001\/archfami.1993.01850040083016"},{"key":"2025082711002488000_14.1.e239355.12","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199301073280104"},{"key":"2025082711002488000_14.1.e239355.13","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-129-11_Part_1-199812010-00004"},{"key":"2025082711002488000_14.1.e239355.14","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1996.00440170161018"},{"key":"2025082711002488000_14.1.e239355.15","doi-asserted-by":"publisher","DOI":"10.1136\/bcr.09.2010.3368"},{"key":"2025082711002488000_14.1.e239355.16","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv319"},{"key":"2025082711002488000_14.1.e239355.17","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2019-233564","article-title":"Postcardiotomy extracorporeal membrane oxygenation in a patient with Austrian syndrome","volume":"13","author":"Edlin","year":"2020","journal-title":"BMJ Case Rep"},{"key":"2025082711002488000_14.1.e239355.18","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.1016\/S1098-3597(06)80053-0","article-title":"Neutropenia: etiology and pathogenesis","volume":"8 Suppl 5","author":"Schwartzberg","year":"2006","journal-title":"Clin Cornerstone"},{"key":"2025082711002488000_14.1.e239355.19","doi-asserted-by":"publisher","DOI":"10.23750\/abm.v91i1.9397"},{"key":"2025082711002488000_14.1.e239355.20","unstructured":"Coronavirus (COVID-19) in the UK. 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