ABSTRACT
Agranulocytosis is a rare, but sometimes dangerous, adverse reaction to allopurinol. We report the unusual case of a 43-year-old man with agranulocytosis, who received allopurinol while undergoing peritoneal dialysis. The bone marrow biopsy indicated that the agranulocytosis was drug-induced. After ceasing all drugs, isolating the patient, and administering granulocyte colony-stimulating factor (G-CSF), the leukocyte count returned to normal. A relationship between allopurinol therapy and agranulocytosis was presumed.
Subject(s)
Adult , Humans , Agranulocytosis , Allopurinol , Biopsy , Bone Marrow , Granulocyte Colony-Stimulating Factor , Leukocyte Count , Peritoneal DialysisABSTRACT
Granulocytopenia, which can be seen in patients with Graves' disease during treatment with antithyroid agents, could be a self resolving transient episode or can imply the beginning of life threatening agranulocytosis requiring a change in treatment modality. Transient granulocytopenia could be a manifestation of hyperthyroidism itself, or a mild side effect of antithyroid drugs. Aganulocytosis is a rare, but major complications of the termination drug, propylthiouracil (PTU), requiring prompt termination of the medication, and intensive care. Therefore, differentiation of agranulocytosis and transient granulocytopenia, is important, but is not practically easy. We introduce a case of transient granulocytopenia, which was detected in a patient with Graves'Disease, accompanied by underlying type 1 diabetes mellitus, during treatment with PTU. Diagnosis of transient granulocytopenia was made by a normal granulocyte count following a single injection of G-SCF, and the patient was treated with conservative therapy. This case confirms a diagnostic tool for differentiating transient granulocytopenia and PTU-induced agranulocytosis.
Subject(s)
Humans , Agranulocytosis , Antithyroid Agents , Beginning of Human Life , Diabetes Mellitus, Type 1 , Diagnosis , Diagnosis, Differential , Granulocyte Colony-Stimulating Factor , Granulocytes , Graves Disease , Hyperthyroidism , Critical Care , PropylthiouracilABSTRACT
Kostmann's disease is a rare hematologic disease entity which is characterized by persistent neutropenia and recurrent bacterial infections since early in infancy. The authors experienced a 2-month-old female infant with disseminated bacterial skin infection since 3 weeks of age and persistent neutropenia. Diagnosis was made by neutropenia in the peripheral blood, maturation arrest of myeloid hemopoiesis at myelocyte stage in the finding of bone marrow aspiration and improving response of neutropenia with G-CSF administration. She had experienced 4 episodes of sepsis and one episode of acute otitis externa during follow-up until 14 months of age.