The authors present 31 cases of acute agranulocytosis due to drugs. 27 resulted from amidopyrine poisoning and 4 were due to phenothiazines. The clinical picture in most cases, was that of severe septicemia with lesions of the mucosae. On blood count agranulocytosis was complete, associated on bone marrow examination with an appearance of selective hypoplasia of the granular series or an aspect of maturation blockage at the stage of the myelocyte or the metamyelocyte. The course was fatal in 6 cases. A search for leukocyte agglutinating antibodies, carried out in 29 cases, was positive in only 5 cases. These facts correspond, on the whole, to the, clinical and etiological data found in the literature. Although the agranulocytoses induced by phenothiazines, seem to be mainly of toxic origin, the agranulocytoses induced by amidopyrine associated both an immunological mechanism and a toxic mechanism. Among all the biological tests proposed, the most useful is the le ukocyte agglutination test, but the serological diagnosis is rarely conclusive.
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BMJ Case Rep
January 2025
Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
This case highlights that refractory pancytopenia leading to death can occur with methimazole treatment even at a very low cumulative dose and after a very short duration of exposure. In addition, the standard treatments to correct the pancytopenia may not be effective and a bone marrow transplant may be required. Current American Thyroid Association guidelines do not recommend routine monitoring of the complete blood count in patients receiving thionamides because of the rapidity of the onset of agranulocytosis and the lack of positive evidence that such monitoring would be useful.
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January 2025
Department of Medical Oncology, Sasebo Kyosai Hospital, Sasebo, Japan.
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Research Center for Traditional Medicine and History of Medicine, Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Centre Hospitalier Universitaire de Poitiers, Infectious Agents Department, Bacteriology Laboratory, Poitiers, France.
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Centre for Precision Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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