Captopril-induced toxic epidermal necrolysis and agranulocytosis successfully treated with granulocyte colony-stimulating factor.
Captopril-induced bone marrow suppression is rare, except in certain high-risk patient populations. Severe exfoliative rashes have also been associated with captopril, but a combined presentation of toxic epidermal necrolysis and agranulocytosis has not been previously described. We report an unusual case of captopril-induced toxic epidermal necrolysis with agranulocytosis in a patient with no known risk factors. The bone marrow suppression was successfully treated using granulocyte colony-stimulating factor (G-CSF), and the white blood cell (WBC) count recovered within 3 days after starting therapy. This case underscores the early experience with captopril, which showed a strong correlation between high doses used to treat hypertension and bone marrow suppression.
Winfred
R I
RI
Department of Medicine, West Virginia University School of Medicine, Morgantown 26505-9214, USA.
Nanda
S
S
Horvath
G
G
Elnicki
M
M
D000380:Agranulocytosis / Q000139:chemically induced* / Q000150:complications / Q000628:therapy; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D002216:Captopril / Q000009:adverse effects*; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D013262:Stevens-Johnson Syndrome / Q000150:complications / Q000628:therapy*
D000806:Angiotensin-Converting Enzyme Inhibitors; D016179:Granulocyte Colony-Stimulating Factor; D002216:Captopril