Gold induced aplastic anemia. Complete response to corticosteroids, plasmapheresis, and N-acetylcysteine infusion.
A 47-year-old woman with rheumatoid arthritis (RA) had been treated with greater than 7 g of gold sodium thiomalate over a 5 year period when aplastic anemia developed. Treatment with corticosteroids, plasmapheresis and infusion of N-acetylcysteine (NAC) resulted in complete hematologic remission. Infusion of NAC increased daily urinary excretion of gold and use of an ambulatory infusion pump with a Hickman catheter allowed protracted outpatient infusion for more than 4 months' duration. It is now 20 months since the onset of aplastic anemia and she remains in complete hematologic remission.
D000111:Acetylcysteine / Q000627:therapeutic use*; D000741:Anemia, Aplastic / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology / Q000628:therapy; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D001853:Bone Marrow / Q000473:pathology; D005260:Female; D006046:Gold / Q000009:adverse effects* / Q000097:blood / Q000652:urine; D006801:Humans; D008875:Middle Aged; D010956:Plasmapheresis; D011241:Prednisone / Q000627:therapeutic use*
D006046:Gold; D011241:Prednisone; D000111:Acetylcysteine