[Role of allopurinol and rofecoxib in agranulocytosis and acute tubular necrosis].
OBJECTIVE
To report the case of a patient who developed a life-threatening agranulocytosis and acute tubular necrosis after the administration of allopurinol and rofecoxib.


METHODS
After minor surgery, a 70-year-old male underwent a routine blood test which encountered: anemia, leucopenia, neutropenia, thrombopenia, and altered creatinine levels. Both marrow and renal biopsies were performed, yielding the following results: acute tubular necrosis and agranulocytosis in the recovery stage. One month and a half before the aforementioned surgery a routine blood test had been performed, which showed normal values. The patient had then received allopurinol 100 mg/day for around 2 months, and rofecoxib 2.5 mg/day for 14 days.


CONCLUSIONS
After ruling out other possible causes, a diagnosis of iatrogenically induced agranulocytosis and acute tubular necrosis was reached. We used a (modified) Karch-Lasagna algorithm with both drugs, and found the following imputability values: possible for rofecoxib and probable for allopurinol. In view of the widespread use of rofecoxib and COX-2 inhibitors, despite their recent availability, and of their potential role in the severe adverse effects discussed, healthcare professionals must be on the alert for the development of symptoms suggesting said or other adverse effects.
Real Panisello
M
M
Servicio de Farmacia, Hospital Universitario Virgen de la Arrixaca, Murcia. farmacia@huva.es
Vila Clérigues
N
N
García Reina
L
L
Luaces Vidal
F
F
González Ponce
C M
CM
Díaz Carrasco
M S
MS
D000368:Aged; D000380:Agranulocytosis / Q000139:chemically induced*; D000493:Allopurinol / Q000009:adverse effects*; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects*; D004791:Enzyme Inhibitors / Q000009:adverse effects*; D006801:Humans; D007683:Kidney Tubular Necrosis, Acute / Q000139:chemically induced*; D007783:Lactones / Q000009:adverse effects*; D008297:Male; D013450:Sulfones
D016861:Cyclooxygenase Inhibitors; D004791:Enzyme Inhibitors; D007783:Lactones; D013450:Sulfones; C116926:rofecoxib; D000493:Allopurinol