Subject(s)
Humans , Female , Middle Aged , Leprosy, Tuberculoid/drug therapy , Dapsone/adverse effects , Agranulocytosis/chemically induced , Leprostatic Agents/adverse effects , Leprosy, Tuberculoid/complications , Risk Factors , Treatment Outcome , Agranulocytosis/drug therapy , Drug Therapy, Combination/adverse effects , Hematologic Agents/therapeutic use , Anti-Bacterial Agents/therapeutic useABSTRACT
La neutropenia en usuarios de cocaína es una condición de reciente reconocimiento en distintos países. Se debe a la utilización del levamisol, una antigua droga antiparasitaria e inmunomoduladora, como agente de corte. Presentamos el caso de un paciente con agranulocitosis por levamisol asociado a cocaína y una revisión de las características del cuadro, así como del control de estos pacientes. También se tratan los motivos vinculados al agregado cada vez más frecuente de levamisol a la cocaína. Este es el primer caso descrito en nuestro país, si bien es probable que existan muchos casos no reconocidos o no comunicados de esta enfermedad.
Agranulocytosis in cocaine users is a worldwide recently recognized condition. It is due to the utilization as cutting agent of levamisole, an ancient antiparasitic and immunomodulator drug. We describe the case of a patient with agranulocytosis induced by levamisole in association to cocaine and we review clinical and biochemical characteristics of the clinical picture, as well as the management of these patients. We also analyze the reasons related to a more and more frequent practice, the addition of levamisole to cocaine. This is the first case described in our country, although it is probable that there are many not recognized or not described cases related to this pathology.
Subject(s)
Adult , Humans , Male , Agranulocytosis/chemically induced , Cocaine-Related Disorders/complications , Cocaine/adverse effects , Levamisole/adverse effects , Agranulocytosis/drug therapy , Treatment OutcomeABSTRACT
A síndrome de Sjögren (SS) é uma doença autoimune caracterizada pela presença de infiltrado linfocítico nas glândulas salivares e lacrimais. Manifestações hematológicas da síndrome de Sjögren primária (SSp) geralmente consistem em anemia leve, trombocitopenia, neutropenia moderada e linfopenia. Agranulocitose é raramente descrita e, em geral, responde bem ao tratamento de imunossupressão. Neste trabalho, descrevemos o caso de uma paciente portadora de SSp que apresentou quadro de agranulocitose refratária ao tratamento. A biópsia de medula revelou medula óssea hipocelular com maturação normal da série granulocítica. A paciente foi sucessivamente tratada com prednisona em altas doses, fator estimulador de colônia de macrófagos e ciclosporina, todos sem resposta hematológica. Micofenolato mofetil (MMF) foi iniciado, e após dois meses houve aumento na contagem das células brancas. Após um ano de seguimento a paciente não apresentou novos episódios de neutropenia, nem complicações infecciosas. Concluímos que, na agranulocitose refratária associada à SSp, o tratamento com MMF pode ser uma opção eficaz e bem tolerada.
The Sjögren's syndrome (SS) is an autoimmune disease characterized by a lymphocytic infiltration of salivary and lacrimal glands. Hematological manifestations of primary SS (pSS) usually consist of mild anemia, thrombocytopenia, moderate neutropenia, and lymphopenia. Agranulocytosis is rarely reported and usually responds to immunosuppression. We report the case of a pSS patient who presented with refractory agranulocytosis. Bone marrow biopsy disclosed a hypocellular bone marrow with normal maturation of the granulocytic series. The patient was successively treated with high-dose prednisone, granulocyte-macrophage colony stimulation factor, and cyclosporine, with no hematological response. Mycophenolate mofetil (MMF) was initiated and after two months there was a rise on the white blood cell count. After one year of follow-up, she had neither further neutropenia episodes, nor infectious complications. We conclude that, in pSS refractory agranulocytosis, MMF can be an effective and well-tolerated treatment option.
Subject(s)
Aged , Female , Humans , Agranulocytosis/drug therapy , Agranulocytosis/etiology , Immunosuppressive Agents/therapeutic use , Mycophenolic Acid/analogs & derivatives , Sjogren's Syndrome/complications , Mycophenolic Acid/therapeutic useABSTRACT
Ciprofloxacin is one of the most commonly used antibacterial agents with relatively few side effects. Serious adverse reactions reported with ciprofloxacin are rare with an incidence of 0.6%. Recently we came across two rare adverse effects of ciprofloxacin, viz. toxic epidermal necrolysis and agranulocytosis. To our knowledge, a total of seven cases have been reported in the literature documenting an association between oral ciprofloxacin administration and toxic epidermal necrolysis. One case of granulocytopenia, four of pancytopenia and fifteen of leucopenia worldwide have been reported. With the use of ciprofloxacin becoming more and more widespread, these two rare but fatal complications of ciprofloxacin should be borne in mind.
Subject(s)
Administration, Oral , Adult , Agranulocytosis/chemically induced , Agranulocytosis/drug therapy , Anti-Bacterial Agents/therapeutic use , Anti-Infective Agents/administration & dosage , Anti-Infective Agents/adverse effects , Ciprofloxacin/administration & dosage , Ciprofloxacin/adverse effects , Stevens-Johnson Syndrome/drug therapy , Stevens-Johnson Syndrome/etiology , Female , Granulocyte Colony-Stimulating Factor/administration & dosage , Granulocyte Colony-Stimulating Factor/therapeutic use , Humans , Leukopenia , Neutropenia , Risk Factors , Sepsis/drug therapy , Thienamycins/therapeutic useABSTRACT
Carbimazole induced agranulocytosis is a relatively rare but serious side effect and potentially fatal condition reported in 0.1-0.5% of cases treated with antithyroid medications. We report a young female with Grave's disease who developed agranulocytosis within 3 weeks of initiation of carbimazole, and recovered within 10 days of treatment with a barrier nursing care, broad-spectrum antibiotics, intravenous corticosteroids and granulocyte colony stimulating factor [G-CSF]. Recovery from agranulocytosis in our case seems compatible with similar cases reported in various areas of the world .We could not reach firm conclusion that the use of G-CSF may hasten recovery time. We noticed an immediate increase in WBC's count, especially neutrophils, following corticosteroid administration
Subject(s)
Humans , Female , Carbimazole/adverse effects , Review , Agranulocytosis/drug therapyABSTRACT
Seräo abordados nesta revisäo apenas alguns dos quadros hematológicos com os quais o clínico se depara mais comumente em uma sala de urgência, como as crises vaso-oclusivas dos pacientes com doenças falciformes, a coagulaçäo intravascular disseminada e a febre no paciente neutropênico
Subject(s)
Humans , Child , Adult , Agranulocytosis/drug therapy , Anti-Bacterial Agents/therapeutic use , Blood Transfusion , Disseminated Intravascular Coagulation/drug therapy , Hemoglobin SC Disease/drug therapy , Emergencies , Fever , Neutropenia/drug therapy , Signs in Homeopathy , Symptoms in Homeopathy , Anticoagulants/therapeutic use , Blood Coagulation Factors , Heparin/therapeutic use , Meperidine/therapeutic use , Priapism/drug therapyABSTRACT
Através de uma objetiva revisäo da literatura, seräo comentadas no texto as peculiaridades que cercam o paciente granulocitopênico febril, com relaçäo ao quadro clínico e microbiológico, e também as mais recentes diretrizes na propedêutica e terapêutica. Após isto, é apresentada a conduta do Serviço de Hematologia e Hemoterapia do Hospital Universitário da Universidade Federal de Juiz de Fora (HU-UFJF), desde os cuidados de enfermagem, exames laboratoriais a serem pedidos e esquemas antibióticos mais comumente usados.
Subject(s)
Agranulocytosis/complications , Gram-Negative Bacteria , Bacterial Infections/microbiology , Agranulocytosis/drug therapy , Agranulocytosis/physiopathology , Anti-Bacterial Agents , Brazil , Fever , Gram-Positive Bacteria , Nursing CareSubject(s)
Acute Disease , Adolescent , Adult , Agranulocytosis/drug therapy , Anti-Bacterial Agents/administration & dosage , Bacterial Infections/prevention & control , Child , Child, Preschool , Drug Therapy, Combination , Female , Fever/drug therapy , Humans , Infant , Leukemia, Lymphoid/complications , Male , Middle Aged , Neutropenia/complicationsABSTRACT
Se presenta un caso de agranulocitosis, en el cual se emplean las medidas del tratamiento convencional (aislamiento, antibióticos de amplio espectro, transfusiones de masa leucocitaria), sin obtenerse resultado alguno, por lo que al décimo día de su ingreso se decide administrar carbonato de litio en dosis de 1 500 mg diarios con lo que se obtiene una evidente mejoría clínica y hematológica. El paciente es egresado posteriormente asintomático, con cifras de leucocitos, granulocitos y medulograma normales. Se hace una revisión bibliográfica del uso terapéutico del carbonato de litio
Subject(s)
Adult , Humans , Male , Agranulocytosis/drug therapy , Lithium/therapeutic useSubject(s)
Valproic Acid/pharmacology , Agranulocytosis/drug therapy , Chloramphenicol/standards , Dipyrone/pharmacology , Hepatitis/drug therapy , Ketoconazole/pharmacology , Mianserin/pharmacology , Pyrazoles/pharmacology , Prenalterol/pharmacology , Tinidazole/standards , Drug and Narcotic Control , Drug Information ServicesABSTRACT
Se presenta un caso de agranulocitosis, en el cual se emplean las medidas del tratamiento convencional (aislamiento, antibiótico de amplio espectro, transfusiones de masa leucocitaria), sin obtenerse resultado favorable alguno, por lo que al décimo día de su ingreso se decide administrar carbonato de litio en dosis de 1 500 mg diarios, con lo que se obtuvo una evidente mejoría clínica y hematológica. El paciente es egresado posteriormente asintomático, con cifras de leucocitos, granulocitos y medulograma normales. Se hace una revisión bibliográfica del uso terapéutico del carbonato de litio