Granulocyte-colony stimulating factor for sulfasalazine-induced agranulocytosis.

OBJECTIVE

To report a case of sulfasalazine-induced agranulocytosis that was successfully treated with granulocyte-colony stimulating factor (G-CSF).

CASE SUMMARY

An 82-year-old woman developed agranulocytosis within two months of initiating sulfasalazine therapy. She was hospitalized, empiric antibiotic and antifungal agents were prescribed, and sulfasalazine therapy was stopped. The patient received G-CSF 600 micrograms/d subcutaneously for six consecutive days, starting on hospital day 5. Agranulocytosis resolved on day 5 and leukopenia on day 6 of G-CSF therapy. No adverse reactions were attributed to administration of this agent and the patient was discharged on hospital day 13.

DISCUSSION

Numerous agents, including sulfasalazine, have been associated with agranulocytosis. Agranulocytic patients frequently experience life-threatening bacterial and fungal infections. Administration of colony stimulating factors may reduce the duration of agranulocytosis and incidence of life-threatening infections.

CONCLUSIONS

G-CSF administration appears to have decreased the duration of this elderly patient's agranulocytosis and hospitalization.