In the modern era of medicine, agranulocytosis is a rare occurrence. Despite significant improvement in patient survival, it still carries significant mortality. Agranulocytosis is most commonly caused by chemotherapeutic agents and numerous non-chemo drugs. As it can develop anytime during treatment and patients can remain asymptomatic, frequent cell count monitoring is an essential tool to make a timely diagnosis. An appropriate drug switch, work up to rule out infection and granulocyte colony-stimulating factor (G-CSF) injection in high-risk cases is the management. The patient should be kept under observation till the resolution of agranulocytosis. We present a case of ceftriaxone-induced agranulocytosis which was completely reversible upon stoppage of drug and granulocyte colony-stimulating factor administration. The pathogenesis of ceftriaxone-induced agranulocytosis is unknown. It is suggested to occur either by an immunologic mechanism or because of direct drug toxicity.

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Extramedullary spread of multiple myeloma was thought to be uncommon but with recent advancements in imaging and increased patient survival, the incidence of the extraosseous disease has risen in living individuals. Despite this, the extraosseous spread of multiple myeloma has been under-diagnosed and under-reported. Timely diagnosis of this extraosseous disease is clinically important, as it indicates a more aggressive disease variant and carries a poor prognosis.