[Idiosyncratic drug-induced agranulocytosis].
BACKGROUND
Agranulocytosis is a life-threatening disorder that frequently occurs as an adverse reaction to drugs.


METHODS
Idiosyncratic drug-induced agranulocytosis is characterized by a neutrophil count <0.5x10(9)/l, in serious forms <0,1x10(9)/l that currently occurs especially in association with antibiotics, antithyroid drugs ant ticlopidine (>60% of the incriminated drugs). The overall incidence of idiosyncratic agranulocytosis ranges from 2.4 to 15.4 cases per million patients exposed to drugs per year. Although patients experiencing idiosyncratic agranulocytosis may be asymptomatic (50%), the severity of the neutropenia usually leads to severe sepsis: fever of unknown origin, septicemia, septic shock or localized documented infections such as sore throat, various cutaneous infections or pneumonia. Nevertheless, the mortality rate of idiosyncratic agranulocytosis is now around 5% with appropriate management.


CONCLUSIONS
In the future, management of drug-induced agranulocytosis may include pre-established procedures using in critically situations, broad-spectrum antibiotic therapy and hematopoietic growth factors (G-CSF).
Andrès
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E
Service de Médecine Interne, Clinique Médicale B, Hôpitaux Universitaires de Strasbourg, France. emmanuel.andres@chru-strasbourg.fr
Maloisel
F
F
D000380:Agranulocytosis / Q000139:chemically induced* / Q000175:diagnosis / Q000401:mortality; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D013956:Antithyroid Agents / Q000009:adverse effects; D003937:Diagnosis, Differential; D005334:Fever / Q000209:etiology; D005343:Fibrinolytic Agents / Q000009:adverse effects; D006801:Humans; D009503:Neutropenia / Q000139:chemically induced; D015996:Survival Rate; D013988:Ticlopidine / Q000009:adverse effects
D000900:Anti-Bacterial Agents; D013956:Antithyroid Agents; D005343:Fibrinolytic Agents; D013988:Ticlopidine