Pfersdorff M, Spes J, Kraus M R
Medizinische Klinik II, Kreiskliniken Altötting-Burghausen.
Dtsch Med Wochenschr. 2011 Feb;136(8):365-8. doi: 10.1055/s-0031-1272537. Epub 2011 Feb 17.
A 17-year-old patient was admitted to the hospital because of fever, shivering and odynophagia. After a pathologic fracture of the neck of the femur because of a preexisting bone cyst he had been taking a combined analgetic therapy with tilidin, metamizole and diclofenac for three weeks. Physical examination was completely normal.
The differential blood count revealed a severe neutropenia of < 100/µl and an elevated C-reactive protein. Several blood cultures were negative. Despite multiple diagnostic procedures no focus of infection could be detected. A bone marrow biopsy showed an impaired maturation of granulocyte precursor cells with a predominance of promyelocytes. Acute leukaemia could be excluded. This finding is typical for a e. g. metamizole-induced agranulocytosis.
Treatment consisted of reverse isolation, intravenous broad-spectrum antibiotics and granulocyte colony-stimulating factors. In the following days, the clinical condition of the patient improved considerably and the neutrophil blood count normalized.
This case report presents the clinical course of an acute drug-induced agranulocytosis. This condition has to be considered as a rare but potentially life-threatening side effect of a variety of drugs, for example metamizole, and requires immediate treatment.
一名17岁患者因发热、寒战及吞咽疼痛入院。因先前存在骨囊肿导致股骨颈病理性骨折后，他接受了替利定、安乃近和双氯芬酸联合镇痛治疗三周。体格检查完全正常。
血常规显示严重中性粒细胞减少，低于100/µl，C反应蛋白升高。多次血培养均为阴性。尽管进行了多项诊断程序，但未发现感染灶。骨髓活检显示粒细胞前体细胞成熟受损，早幼粒细胞占优势。可排除急性白血病。这一发现是例如安乃近诱导的粒细胞缺乏症的典型表现。
治疗包括反向隔离、静脉注射广谱抗生素和粒细胞集落刺激因子。在接下来的几天里，患者的临床状况明显改善，中性粒细胞计数恢复正常。
本病例报告展示了急性药物性粒细胞缺乏症的临床病程。这种情况必须被视为多种药物（如安乃近）罕见但可能危及生命的副作用，需要立即治疗。
