title: Phenytoin-induced agranulocytosis: a nonimmunologic idiosyncratic reaction?
abstract: Agranulocytosis is a rare side effect of phenytoin treatment. We describe the case of an elderly man who developed agranulocytosis 2 weeks following initiation of phenytoin treatment, on no cytotoxic drugs or any other medications except decadron. The white blood cell count was 300/mm3 with absent granulocytes. The liver enzymes were also noted to be newly elevated. Complete workup showed no evidence of infection. The patient was managed as a case of neutropenic fever and phenytoin was discontinued. A bone marrow biopsy showed absent granulocyte precursors after myelocytes, and an antigranulocyte antibody titer was negative, which suggests a direct toxic effect rather than an immunologic phenomenon. Both agranulocytosis and hepatitis were readily reversible on phenytoin cessation.
authors.affiliation: Department of Radiology, St. Louis University Medical Center, Mo.
authors.forename: M J
authors.initials: MJ
authors.lastname: Sharafuddin
authors.forename: R G
authors.initials: RG
authors.lastname: Spanheimer
authors.forename: G L
authors.initials: GL
authors.lastname: McClune
mesh_terms: D000380:Agranulocytosis / Q000139:chemically induced* / Q000175:diagnosis; D001932:Brain Neoplasms / Q000150:complications / Q000556:secondary; D002294:Carcinoma, Squamous Cell / Q000150:complications; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000150:complications; D010672:Phenytoin / Q000009:adverse effects*; D012640:Seizures / Q000188:drug therapy / Q000209:etiology
chemical_list: D010672:Phenytoin