Grépilloux D, Guéneau C, Weinhard J, Richaud R, Chevallier E, Jouve T, Dusserre J, Rostaing L. Toxic agranulocytosis following nitazoxanide treatment for norovirus diarrhea in a kidney transplant recipient: A case report and review of literature. World J Transplant 2025; 15(4): 105905 [DOI: 10.5500/wjt.v15.i4.105905]
Corresponding Author of This Article
Lionel Rostaing, MD, PhD, Professor, Department of Nephrology, Hemodialysis, Apheresis, and Kidney Transplantation, Grenoble University Hospital, CS10217, Grenoble 38043, France. lrostaing@chu-grenoble.fr
Research Domain of This Article
Transplantation
Article-Type of This Article
Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 18, 2025 (publication date) through Nov 19, 2025
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Journal Information of This Article
Publication Name
World Journal of Transplantation
ISSN
2220-3230
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Grépilloux D, Guéneau C, Weinhard J, Richaud R, Chevallier E, Jouve T, Dusserre J, Rostaing L. Toxic agranulocytosis following nitazoxanide treatment for norovirus diarrhea in a kidney transplant recipient: A case report and review of literature. World J Transplant 2025; 15(4): 105905 [DOI: 10.5500/wjt.v15.i4.105905]
Dorian Grépilloux, Corentin Guéneau, Jules Weinhard, Rémi Richaud, Eloi Chevallier, Thomas Jouve, Julien Dusserre, Lionel Rostaing, Department of Nephrology, Hemodialysis, Apheresis, and Kidney Transplantation, Grenoble University Hospital, Grenoble 38043, France
Thomas Jouve, Lionel Rostaing, Department of Medicine, Université Grenobles-Alpes, Grenoble 38000, France
Author contributions: Jouve T contributed to conceptualization, methodology and validation; Weinhard J and Richaud R contributed to investigation; Grépilloux D, Guéneau C, and Dusserre J contributed to writing and original draft preparation; Rostaing L contributed to writing, review and editing; Chevallier E contributed to supervision.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lionel Rostaing, MD, PhD, Professor, Department of Nephrology, Hemodialysis, Apheresis, and Kidney Transplantation, Grenoble University Hospital, CS10217, Grenoble 38043, France. lrostaing@chu-grenoble.fr
Received: February 21, 2025 Revised: April 24, 2025 Accepted: September 24, 2025 Published online: December 18, 2025 Processing time: 271 Days and 12.4 Hours
Abstract
BACKGROUND
In France, nitazoxanide is available through compassionate use authorization, as there is no summary of product characteristics for this medication. However, it has been marketed in the United States for several years, with evidence supporting its use in the treatment of chronic norovirus infections in immunocompromised individuals. Due to its limited use, data on the efficacy and safety of this drug remain sparse.
CASE SUMMARY
We report the case of a 79-year-old immunocompromised patient, a renal transplant recipient undergoing treatment with mycophenolate mofetil and tacrolimus, who developed toxic agranulocytosis, as absolute neutrophil count dropped from 2.93 G/L to 0.09 G/L within 17 days following the introduction of nitazoxanide for the treatment of chronic diarrhea caused by norovirus infection. Clinical and laboratory findings suggest a toxic mechanism, most likely attributable to nitazoxanide.
CONCLUSION
This case highlights the potential of nitazoxanide to induce dose-dependent toxic agranulocytosis. While this adverse effect does not necessarily contraindicate reintroduction of the drug, it underscores the necessity for close hematological monitoring in such cases.
Core Tip: Nitazoxanide is a thiazolide compound. The Food and Drug Administration has approved it for the treatment of Giardia intestinalis and Cryptosporidium parvum infections in immunocompromised patients aged 12 years or older. In immunocompromised patients, nitazoxanide use for chronic Norovirus diarrhea has been reported and appears promising, including in solid organ transplant recipients. However, the drug is not yet approved for this indication. We herein report on a patient for which nitazoxanide induced a dose-dependent toxic agranulocytosis.
