Mielosupresión inducida por linezolid: un caso pediátrico / Myelosupression induced by linezolid: a pediatric case

El linezolid es un antibiótico de la familia de las oxazolidinonas, que actúa inhibiendo la síntesis proteica. Se emplea en infecciones graves por cocos Gram-positivos multirresistentes. Sus principales efectos secundarios son los gastrointestinales y, con menor frecuencia, la neuropatía periférica, la acidosis láctica y la mielosupresión. Se presenta el caso clínico de un niño de 12 años con diagnóstico de osteoartritis séptica de cadera derecha con osteomielitis femoral en tratamiento con linezolid, que presentó un cuadro de intolerancia digestiva, asociado a astenia y pérdida de peso. Presentaba, además, anemia normocítica, junto con leucopenia y trombopenia leves, con datos sugestivos de alteración de la hematopoyesis en el frotis sanguíneo, sugerente de toxicidad por fármacos. El cuadro se resolvió con la interrupción de la administración del fármaco. La mielosupresión reversible asociada a linezolid se relaciona con tratamientos prolongados (> 28 días), por lo que son necesarios los controles hematológicos periódicos durante ellos.

Linezolid is an antibiotic of oxazolidinones family that inhibits proteical synthesis. It is used in several Gram-positive multirresistent infections. Its more frequent side effects are gastrointestinal, followed by peripheral neuropathy and myelosuppression. We report the case of a 12-year-old boy diagnosed with septic osteoarthritis of the hip and femoral osteomyelitis, following treatment with linezolid, who complained about digestive intolerance and weight loss. He showed severe normocytic anemia and mild leukopenia and thrombocytopenia with data of hematopoiesis disorder in the blood smear that suggested drug toxicity. These findings reverted when the treatment was discontinued. Reversible myelosuppression associated with linezolid is related to long treatments (more than 28 days). So it is necessary to check the blood count during long treatments.

Ulcerations due to methotrexate toxicity in a psoriasis patient

Abstract: Methotrexate is one of the most used drugs in the treatment of psoriasis with indication of systemic therapy. Cutaneous and mucous side effects are described by pharmacological characteristics of the drug itself or due to overdose. We report the case of a patient with ulcerations in oral mucosa and psoriatic plaques after incorrect use of Methotrexate. Prescribed in a weekly dose, it was used continuously for 10 days and without simultaneous intake of folic acid. It is important to ensure correct comprehension of the prescription.

Quality of life/spirituality, religion and personal beliefs of adult and elderly chronic kidney patients under hemodialysis / Qualidade de vida/espiritualidade, religião e crenças pessoais de adultos e idosos renais crônicos em hemodiálise / Calidad de vida/espiritualidad, religión y creencias personales de adultos y ancianos renales crónicos en hemodiálisis

OBJECTIVE: to assess the quality of life of chronic kidney patients undergoing hemodialysis, using the WHOQOL-bref and WHOQOL-SRPB. METHOD: a descriptive and cross-sectional study was undertaken at a kidney replacement therapy service in the interior of the state of SP. The 110subjects who complied with the inclusion criteria answered the Subject Characterization Instrument, the WHOQOL-bref and WHOQOL-SRPB. RESULTS: most of the respondents were male (67.27%), with a mean age of 55.65 years, Catholic (55.45%), with unfinished primary education (33.64%) and without formal occupation (79.08%). The WHOQOL-bref domains with the highest and lowest mean score were, respectively, "psychological" (µ=74.20) and "physical" (µ=61.14). The WHOQOL-SRPB domains with the highest and lowest mean score were, respectively, "completeness and integration" (µ=4.00) and "faith" (µ=4.40). CONCLUSIONS: the respondents showed high quality of life scores, specifically in the dimensions related to spirituality, religion and personal beliefs. Losses were evidenced in the physical domain of quality of life, possibly due to the changes resulting from the chronic kidney disease and hemodialysis treatment. .

OBJETIVO: avaliar a qualidade de vida de pacientes renais crônicos em hemodiálise, por meio do WHOQOL-bref e WHOQOL-Spirituality, Religion and Personal Beliefs. MÉTODO: trata-se de um estudo descritivo, de corte transversal, realizado em uma unidade de terapia renal substitutiva do interior do Estado de São Paulo. Os 110 sujeitos que atenderam os critérios de inclusão responderam ao Instrumento de Caracterização dos Sujeitos, ao WHOQOL-bref e WHOQOL-Spirituality, Religion and Personal Beliefs. RESULTADOS: a maioria dos respondentes era do sexo masculino (67,27%), com idade média de 55,65 anos, católica (55,45%), com ensino fundamental incompleto (33,64%) e sem ocupação formal (79,08%). Os domínios do WHOQOL-bref com maior e menor pontuação média foram, respectivamente, "psicológico" (µ=74,20) e "físico" (µ=61,14). Os domínios do WHOQOL-Spirituality, Religion and Personal Beliefs de menor e maior pontuação média foram, respectivamente, "totalidade e integração" (µ=4,00) e "fé" (µ=4,40). CONCLUSÕES: os respondentes apresentaram elevados escores de qualidade de vida, especificamente nas dimensões referentes à espiritualidade, religião e crenças pessoais. Evidenciaram-se prejuízos no domínio físico da qualidade de vida, possivelmente em decorrência das alterações resultantes da doença renal crônica e do tratamento hemodialítico. .

OBJETIVO: evaluar la calidad de vida de pacientes renales crónicos en hemodiálisis, por medio del WHOQOL-bref y WHOQOL-SRPB. MÉTODO: se trata de un estudio descriptivo, de corte transversal, realizado en una unidad de terapia renal substitutiva del interior del estado de SP. Los 110 sujetos que atendieron a los criterios de inclusión respondieron al Instrumento de Caracterización de los Sujetos, al WHOQOL-bref y WHOQOL-SRPB. RESULTADOS: la mayoría de los entrevistados era del sexo masculino (67,27%), con edad promedio de 55,65 años, católicos (55,45%), con enseñanza fundamental incompleta (33,64%) y sin ocupación formal (79,08%). Los dominios del WHOQOL-bref con mayor y menor puntuación promedio fueron, respectivamente: "psicológico" (µ=74,20) y "físico" (µ=61,14). Los dominios del WHOQOL-SRPB de menor y mayor puntuación promedio fueron, respectivamente: "totalidad e integración" (µ=4,00) y "fe" (µ=4,40). CONCLUSIONES: los entrevistados presentaron elevados puntajes de calidad de vida, específicamente en las dimensiones referentes a espiritualidad, religión y creencias personales. Se evidenciaron perjuicios en el dominio físico de la calidad de vida, posiblemente en consecuencia de las alteraciones resultantes de la enfermedad renal crónica y del tratamiento de hemodiálisis. .

Leucopenia grave em paciente com artrite reumatoide tratada com combinação de metotrexato e leflunomida / Severe leukopenia in a rheumatoid arthritis patient treated with a methotrexate/leflunomide combination

Apresentamos o caso de uma paciente com artrite reumatoide tratada por dois anos com associação de metotrexato e leflunomida. A paciente foi internada com leucopenia grave quatro semanas após acrescentar ao esquema medicamentoso as drogas clopidogrel, isosorbida, sinvastatina, AAS e omeprazol.

A rheumatoid arthritis patient was treated for two years with methotrexate and leflunomide combination therapy. The evolution was uneventful until she had clopidogrel, simvastatin, isosorbide, aspirin and omeprazole added to medication due to acute myocardial infarction. Four weeks after this, she was hospitalized with severe leukopenia.

Factor estimulante de colonias de granulocitos en pacientes con cáncer / Granulocyte-colony stimulating factor in patients with cancer

Se efectuó un estudio descriptivo, longitudinal y prospectivo de 26 pacientes con cáncer en diferentes localizaciones asociado a leucopenia y neutropenia inducidas por citotóxicos, atendidos en el Servicio de Quimioterapia del Hospital Oncológico Docente Conrado Benítez de Santiago de Cuba, de mayo del 2011 a igual mes del 2012, con vistas a determinar el efecto del factor de colonias granulocítica recombinante Ior® LeukoCIM --producido por el Centro de Inmunología Molecular de Ciudad de La Habana-- en ellos mediante la realización de conteos globales de leucocitos y neutrófilos, antes y después de aplicar el tratamiento. En la serie predominaron el sexo femenino, el cáncer de mama y el estadio clínico II; también se obtuvo que 92,3 por ciento de los pacientes respondieron satisfactoriamente a la terapia, el estadio clínico del cáncer no modificó el efecto mielodepresor de los citotóxicos ni el mieloestimulador de la hormona, y el cisplatino y la adriamicina se relacionaron con las neutropenias mayores y la falta de reacción al factor. Para finalizar, el Ior® LeukoCIM estimuló el sistema granulopoyético de la mayoría de los afectados

A descriptive, longitudinal and prospective study was conducted in 26 patients with cancer in different locations associated with leukopenia and neutropenia induced by cytotoxic drugs, treated at the Chemotherapy Department of Conrado Benítez Teaching Oncology Hospital of Santiago de Cuba, from May 2011 to the same month of 2012, with the purpose of determining the effect of the recombinant granulocyte-colony factor Ior® LeukoCIM --produced by the Center of Molecular Immunology in Havana city-- in them by means of global counts of leukocytes and neutrophils before and after applying the treatment. Female sex, breast cancer and clinical stage II prevailed in the series. It was also found that 92.3 percent of patients responded successfully to the therapy, the clinical stage of cancer did not modify the myelosuppressive effect of cytotoxic drugs nor the myelostimulating effect of hormone, and cisplatin and adriamycin were related to higher neutropenia and lack of reaction to the factor. Finally, the Ior® LeukoCIM stimulated the granulopoietic system of most patients

Leucopenia e trombocitopenia induzidas por etanercepte: relato de dois casos e revisão da literatura / Leukopenia and thrombocytopenia induced by etanercept: two case reports and literature review

O fator de necrose tumoral alfa (TNF-alfa) é uma citocina pró-inflamatória, e seu excesso pode levar a sérias consequências. Esses efeitos são conhecidos por serem antagonizados por inibidores da atividade do TNF-alfa. O etanercepte é uma proteína de fusão que inibe a ação do TNF-alfa. Como a regulação do TNF-alfa está relacionada à diferenciação celular de várias células envolvidas na resposta imunológica por meio da expressão de várias outras citocinas, é possível que o uso de inibidores dessa citocina possa causar citopenia. Relatamos dois casos de bicitopenia induzidos por etanercepte. Em ambos os casos houve melhora clínica do quadro após a retirada da medicação. Discutimos a necessidade da introdução de testes laboratoriais de rotina em pacientes que usam terapia anti-TNF, para identificar possíveis alterações hematológicas.

Tumor necrosis factor-alpha (TNF-alpha) is a proinflammatory cytokine, and its excess can lead to severe consequences. Those effects are known to be antagonized by TNF-alpha inhibitors. Etanercept is a fusion protein that inhibits TNF-alpha action. As TNF-alpha regulation is related to cellular differentiation of various cellular types involved in immune response through expression of several other cytokines, it is possible that the use of its inhibitors may cause cytopenia. We report two cases of bicytopenia induced by etanercept. Both cases recovered after drug withdrawal. We discuss the need of introduction of routine laboratorial tests in patients using anti-TNF therapy, in order to identify possible hematological changes.

Treatment induced leucopenia in hepatitis C and role of G-CSF in its management

To determine the frequency and severity of leucopenia during antiviral treatment in patients with hepatitis C and the effectiveness of G-CSF [Granulocyte-Colony Stimulating Factor] in its management. An observational study. Shafi Clinic, Rawalpindi, from July 2005 to July 2007. Patients with Polymerase Chain Reaction [PCR] positive for Hepatitis C Virus-Ribonucleic Acid [HCV-RNA] by Enzyme Linked Immunosorbent Assay [ELISA] method were included in the study. Standard combination therapy was given to all i.e. interferon and ribavirin. Those with total leukocyte count [TLC] <4000/cmm were given injection Granulocyte-Colony Stimulating Factor [G-CSF] according to severity of leucopenia. Response to therapy was noted and dose titration was done accordingly. A total of 208 patients were enrolled in the study with 99 [48%] males and 109 [52%] females. Total leukocyte count [TLC] < 4000/cmm was observed in 78 [37.5%] cases. Conventional interferon induced leucopenia was seen in 60 out of 172 [35%] cases. Pegylated interferon induced leucopenia was seen in 18 out of 36 [50%] cases. Patients on Pegylated interferon had more severe leucopenia as compared to those on conventional interferon. Granulocyte-Colony Stimulating Factor [G-CSF] administration resulted in an increase in mean total leukocyte count from 2300 to 5200/cmm. No patient required antiviral dose reduction or discontinuation. Recombinant Granulocyte-Colony Stimulating Factor [G-CSF] administration tends to manage leucopenia, which is a common adverse effect of antiviral treatment for hepatitis C

Toxicidade da azatioprina na doença de Crohn: incidência, abordagem e evolução / Azathioprine toxicity in Crohn's disease: incidence, approach and course

OBJETIVO: A azatioprina (AZA) tem sido usada freqüentemente no tratamento da doença de Crohn (DC). O objetivo do presente estudo foi avaliar a freqüência, evolução e abordagem dos efeitos adversos da AZA no tratamento de pacientes com DC. MÉTODOS: Foram incluídos prospectivamente 106 pacientes portadores de DC em uso de AZA, de janeiro de 2002 a dezembro de 2006. Registraram-se dados clínicos e demográficos, com controle laboratorial mensal dos efeitos hematológicos e supervisão de reações adversas por meio de avaliação clínica. Realizou-se comparação entre os grupos com e sem efeitos adversos. RESULTADOS: Cinqüenta e seis (52,7 por cento) dos pacientes estudados apresentaram pelo menos um efeito adverso, requerendo redução transitória da dose da droga; 18 (17 por cento) necessitaram suspender definitivamente o uso de AZA, geralmente devido a reações de hipersensibilidade. Náuseas e vômitos, freqüentemente leves, ocorreram em 29 (27,4 por cento); a raça negra e aqueles com comorbidades apresentaram mais intolerância gástrica do que os brancos e aqueles sem outras doenças associadas (p=0,04). Leucopenia foi o efeito adverso mais freqüente, ocorrendo em 36 (34 por cento). O tempo de uso de AZA foi maior em pacientes com leucopenia do que nos não leucopênicos (p=0,001), enquanto a dose média de AZA foi menor naqueles com leucopenia comparados aos não leucopênicos (p=0,005). Não houve infecções graves, neoplasias ou óbitos durante o tratamento com AZA. CONCLUSÃO: A AZA mostrou ser uma droga relativamente segura no tratamento da DC, desde que seja mantida supervisão clínica e laboratorial periódica durante todo o tratamento.

OBJECTIVE: Azathioprine (AZA) is frequently used in Crohn's disease (CD) therapy. This paper aimed to evaluate the frequency, evolution and management of AZA side effects in CD patients. METHODS: One hundred and six CD patients under AZA therapy were evaluated prospectively from January 2002 to December 2006. Clinical and demographic data were recorded, together with a monthly laboratory control of hematological or other adverse reactions by means of clinical evaluation. Comparison was carried out between groups with and without side effects. RESULTS: At least one adverse reaction was found in 56 (52.7 percent) of the patients studied and required a transient drug reduction; 18 (17 percent) had to definitely stop use of AZA, often because of hypersensitivity reactions. Nausea, vomit, although slight, occurred in 29 (27.4 percent). The black race and those with co-morbidities had more gastric intolerance than Caucasians and those without other associated disease (p=0.04). Leucopoenia was the more frequent side effect observed, occurring in 36 (34 percent). The period of AZA use was longer for patients with leucopoenia than for those without (p=0.001), while the mean dose of AZA was lower for those with leucopoenia when compared to non-leucopoenics (p=0.005). No serious infections, malignancy or death was noticed as a consequence of AZA use. CONCLUSION: In this study use of AZA in therapy for Crohn's disease disclosed that the drug is satisfactorily safe as long as periodical clinical and laboratory supervision is carried out during treatment.

The Frequency and the Course of the Adverse Effects of Azathioprine/6-Mercaptopurine Treatment in Patients with Inflammatory Bowel Disease / 대한소화기학회지

BACKGROUND/AIMS: This study was to evaluate the frequency and the course of the adverse effects of AZA/6-MP in Korean patients with inflammatory bowel disease (IBD). METHODS: Medical records of the patients with IBD treated with AZA/6-MP at Severance hospital from June 1996 to September 2006 were retrospectively analyzed. RESULTS: A total of 133 patients were studied. Male to female ratio was 1.3:1. The mean age was 31.7+/-10.9 year. Adverse effects included leukopenia occurred in 75 cases (56.4%), nausea/vomiting in 32 cases (24.1%), arthralgia in 6 cases (4.5%), hepatitis in 6 cases (4.5%), skin rash in 4 cases (3.0%), herpes zoster in 3 cases (2.3%), and headache in 1 case (0.8%). Most of leucopenia (58.7%) developed within 3 months after maximal tolerated dose of AZA/6-MP and nausea/vomiting frequently occurred within 3 months after start of AZA/6-MP treatment. Thirty-eight patients (28.6%) required the discontinuation of medication due to adverse effects. CONCLUSIONS: Leukopenia was the most common adverse effect of AZA/6-MP treatment. Leukopenia and nausea/vomiting developed frequently in the early period of treatment of AZA/6-MP in patients with IBD. AZA/6-MP should be used cautiously to scrutinize bone marrow suppression.

The Frequency and the Course of the Adverse Effects of Azathioprine/6-Mercaptopurine Treatment in Patients with Inflammatory Bowel Disease / 대한소화기학회지

No abstract available.

Two Cases of Acute Leukopenia Induced by Colchicine with Concurrent Immunosuppressants Use in Behcet's Disease

Colchicine-induced leukopenia usually occurrs in intentional or accidental overdoses or inappropriate use in combination with intravenous and oral colchine; however, there have been several reports of hematologic toxicity in short-term and small-dose colchicine medication courses. We present two cases of leukopenia induced by colchicine use concurrent with immunosuppressants in Behcet's disease. We postulate that the mechanism of colchicine-induced leukopenia might be the destruction of circulating leukocytes and an inhibition of leukocyte production by the immediate and direct toxic effect of colchicine on idiosyncrasies unique to each patient. The concurrently administered immunosuppressant might decrease the threshold for hematologic toxicity of colchicine in the leukocytes and their precursor cells.

The incidence of clozapine-induced leukopenia in patients with schizophrenia at Srinagarind Hospital.

OBJECTIVE: Define the incidence of clozapine-induced leukopenia, neutropenia, and agranulocytosis in patients with schizophrenia at Srinagarind Hospital. MATERIAL AND METHOD: A descriptive study was done by retrospective reviews of the medical records of schizophrenic outpatients at psychiatric clinic in Srinagarind Hospital who had received clozapine from January 1st, 2003 to December 31st, 2005. The demographic data, incidence rate, and incidence density of leukopenia, neutropenia, and agranulocytosis were collected. RESULTS: One hundred and seventeen medical records were reviewed, 65 patients met the inclusion criteria. One patient developed neutropenia. The incidence rate of neutropenia was 1.5% and the incidence density of neutropenia was 0.01/year. No leukopenia or agranulocytosis was found in the present study. The complete blood counts were not obtained regularly due to the problems of patient's adherence and variations in practice among the physicians. CONCLUSION: Neutropenia is uncommon. No leukopenia and agranulocytosis were found. According to variations of incidence reports among different studies, the monitoring of white blood count should be continued.

Effect of antiviral therapy on hematological parameters in patients with chronic hepatitis

To find out the effect of antiviral therapy on hematological parameters in patients of chronic hepatitis. Interventional descriptive study. Military hospital [MH] Rawalpindi Pakistan from May to Oct 2004. 31 patients admitted to M.H Rawalpindi for treatment of chronic hepatitis were studied. Their hematological parameters including Total Leucocyte count [TLC], Haemoglobin [Hb] and Platelet count [Plt] were recorded before starting antiviral therapy and then at 3 monthly intervals. All the patients were given Inj Alpha-Interferon [INF] and Tab Ribavirin as antiviral therapy. Data was collected over a period of 6 months. Descriptive statistics were applied to the recorded data using SPSS ver-10.0 for analysis. 31 patients with mean age +/- SD 38.58 +/- 8.85 years [range 16-49 years] were studied. There was mean hemoglobin [Hb] fall of 0.87g/dl at 3 months and 2g/dl at 6 months of antiviral therapy. Mean Total leukocyte count [TLC] fall of 1.30x10[9]/L at 3 months and 1.87x109/L was noted at 6 months. Similar downward trend was noted in Platelet [Plt] values with mean fall of 23.19x10[9]/mm[3] and 28.29/ mm[3] at 3 and 6 months of antiviral therapy respectively. 10% of the cases developed clinically significant anemia as evidenced by hemoglobin 11g/dl after 6 months of antiviral therapy. Clinically significant leucopenia [< 2.5x10[9]/l] was noted in 7% of the cases. This fall was noted only in first three months of treatment. There is significant decrimental response of hematological parameters to antiviral therapy

Comparison of the Efficacy of Oral Capecitabine versus Bolus 5-FU in Preoperative Radiotherapy of Locally Advanced Rectal Cancer

The effects of treatment with oral capecitabine vs. bolus 5-FU, administered concurrently with preoperative radiotherapy, were compared in the treatment of locally advanced rectal cancer (LARC). One hundred and twenty-seven patients with LARC received concurrent preoperative chemoradiation using two cycles bolus 5-FU (500 mg/m2/day) plus leucovorin (LV, 20 mg/m2/day) (Group I). Another LARC group received concurrent chemoradiation using two cycles 1,650 mg/m2/day of oral capecitabine and 20 mg/m2/day of LV (Group II, 97 patients). Radiation was delivered to the primary tumor at 50.4 Gy in both groups. Definitive surgery was performed 6 weeks after the completion of chemoradiation. A pathologic complete remission was achieved in 11.4% of patients in Group I and in 22.2% of patients in Group II (p= 0.042). The down-staging rates of the primary tumor and lymph nodes were 39.0/ 68.7% in Group I and 61.1/87.5% in Group II (p=0.002/0.005). Sphincter-preserving surgery was possible in 42.1% of patients in Group I and 66.7% of those in Group II (p=0.021). Grade 3 or 4 leucopenia, diarrhea, and radiation dermatitis were statistically more prevalent in Group I than in Group II, while the opposite was true for grade 3 hand-foot syndrome. Preoperative chemoradiation using oral capecitabine was better tolerated than bolus 5-FU and was more effective in the promotion of both down-staging and sphincter preservation in patients with LARC.

Temozolomide Chemotherapy in Patients with Recurrent Malignant Gliomas

Numerous studies have demonstrated the clinical activity of temozolomide, a second-generation alkylating agent, against malignant brain tumors, however, its activity has not been reported in an Asian population. This study analyzed the efficacy and toxicity of temozolomide in 25 adult patients with recurrent or progressive malignant gliomas after surgery and standard radiation therapy with or without chemotherapy, enrolled in our institution since July 2000. Sixteen patients had glioblastoma multiforme (GBM), six with anaplastic astrocytoma, and three with anaplastic oligodendroglioma. Of the 25 patients, 3 (12%) achieved a complete response (CR), 8 (32%) achieved a partial response (PR), 6 (24%) had stable disease (SD), and 8 (32%) had progressive disease (PD). Two patients achieved a CR, 4 patients achieved a PR, 3 patients had SD and 7 patients had PD in GBM, and 1 patient achieved a CR, 4 patients achieved a PR, 3 patients had SD, 1 patient had PD in the non-GBM patients. Median progression free survival was 8 weeks in GBM and 22 weeks in the non-GBM patients. The median overall survival of each group was 17 weeks and 28 weeks. Temozolomide demonstrated moderate activity in recurrent and progressive malignant gliomas without serious toxicity.

Terapéutica de pénfigo-no esteroidea / Non-steroid therapy in pemphigus

Se hace una revisión de los recursos terapéuticos no esteroideos, empleados en el tratamiento de las diferentes formas clínicas de pénfigo. Se enumeran los factores que condicionan la elección de dicha terapéutica; forma clínica, edad, embarazo, concomitancia con otras enfermedades, interacción con otros fármacos y efectos adversos. El esteroide continúa siendo la droga de primera elección, debiendo estar asociado con otras medicaciones adyuvantes, habitualmente desde su inicio, a fin de promover un descenso más rápido del mismo, con menor incidencia de complicaciones. En los pénfigos graves se preferirá su asociacián con inmunosupresores, en primer lugar con la azatioprina o bien con ciclofosfamida. La dapsona, como las tetraciclinas, será alternativa para algunas formas más leves de pénfigo, mientras que los pulsos de ciclofosfamida, así como la plasmaféresis, deberán reservarse para aquellos casos graves que no hayan respondido a las terapéuticas convencionales