title: Agranulocytosis following phenytoin-induced hypersensitivity syndrome.
abstract: Phenytoin, one of the most common antiepileptic drugs, is a major cause of antiepileptic drug hypersensitivity syndrome (AHS), which is a rare but potentially fatal complication. We herein report a 5-year-old boy who developed unexpected agranulocytosis with fever approximately one week after recovering from the typical symptoms of AHS, characterized by fever, rash, lymphadenopathy, and hepatitis, but lacking eosinophilia or lymphocytosis. High-dose steroid therapy for the former symptoms of AHS, and immunoglobulin, granulocyte colony-stimulating factor, and cefepime for the latter agranulocytosis were successfully performed. This unexpected progression from AHS to agranulocytosis shortly after recovering from the former should be recognized as another risk of AHS, possibly leading to a life-threatening condition.
authors.affiliation: Department of Pediatrics, School of Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan. susumu.ito@nifty.com
authors.forename: Susumu
authors.initials: S
authors.lastname: Ito
authors.forename: Mutsuki
authors.initials: M
authors.lastname: Shioda
authors.forename: Kaori
authors.initials: K
authors.lastname: Sasaki
authors.forename: Kaoru
authors.initials: K
authors.lastname: Imai
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Oguni
authors.forename: Makiko
authors.initials: M
authors.lastname: Osawa
mesh_terms: D000380:Agranulocytosis / Q000139:chemically induced* / Q000188:drug therapy / Q000503:physiopathology*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000927:Anticonvulsants / Q000009:adverse effects*; D000077723:Cefepime; D002511:Cephalosporins / Q000008:administration & dosage; D056486:Chemical and Drug Induced Liver Injury / Q000188:drug therapy / Q000503:physiopathology; D002675:Child, Preschool; D018450:Disease Progression; D004342:Drug Hypersensitivity / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology*; D004827:Epilepsy / Q000188:drug therapy; D005076:Exanthema / Q000139:chemically induced; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008206:Lymphatic Diseases / Q000139:chemically induced / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D010672:Phenytoin / Q000009:adverse effects*; D012307:Risk Factors; D013256:Steroids / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000927:Anticonvulsants; D002511:Cephalosporins; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D013256:Steroids; D016179:Granulocyte Colony-Stimulating Factor; D010672:Phenytoin; D000077723:Cefepime