Vedolizumab-related agranulocytosis with Epstein-Barr virus esophagitis: A case report

Vedolizumab has a good safety profile for the treatment of inflammatory bowel disease. Agranulocytosis is a rare but fatal condition. Although many drugs are considered to have a high risk of agranulocytosis, no previous study has mentioned vedolizumab. A 71-year-old female with Sjogren's syndrome received vedolizumab treatment for moderate to severe ulcerative colitis. Her symptoms improved; however, leukopenia was noted after the first dose. Four days after the second dose, she complained of oral and chest pain. Agranulocytosis, oral candidiasis, and Epstein-Barr virus esophagitis with ulceration were noted. After granulocyte-colony stimulating factor treatment, the white blood cell count returned to normal and the esophageal ulcers healed. Vedolizumab is a very safe gut-selective biologic agent, but it also carries the risk of agranulocytosis.