Erythroid hypoplasia associated with chloramphenicol therapy.

I. 1’.: .‘\O. 42908-H. ‘l’he patient, a 20 year old \viutd lemimaic, was admitted to the hos1)itill 0,1 jumly 10, 1957, “for the enlargement of the neck amul eyes.” I)iagnosis of Graves’ (li5C i5e was Iiiil(iC imicl a therapeumtic diose of 12.3 inc. of I’s’ vas administered. On Noveiiiber 5, 1957, slw vas readmitted oh the oplitimalmiiology service l)ecause of the developmiient of iiialignamit exO1)iitlialliios Witll cormical ulceration of the left eye. She was still miidly hypothyroid1. Her weight was 1 14 poumn(ls. A blood count on adlmissiofl revealed tile follouu’ing: He,,ioglobiii 1 1.9 Ciii. i) r cent, \\BC 6300, cum.mlilii., with P\IN 81 P r cent, still) formiis 2 P(’r cent, lymphocytes 16 per cent, miionocytes 1 per cent. She was treated! with I)iamox 230 mg. 4 times a day and a suilfonamuidle preparatiomi, Cantrisimi 2 Gui. every six lioumrs, orally. Adlministration of predmlisomle, 10 mug. every six hours, and l(j*Ie(flIS 1)ellicillili, 1 ,000,00() units every four houmrs, was l)egu,ml two days later. Throumglm Solile Iilisumnd!erstamlding, the patient also received chloramliphenico! 3 Gm. every six hours for 14 clays. Omie week later the close of predmiisone was imlcreased to 20 mug. every six hours. The admninistratioml of triioclothyromiine 50 pc. every six hours and ACTH gel 40 units every 12 hours was begumn. On November 15, 1957, she was seen imi comisultation because of namm.sea with vomiting of small amiiounts d)f blood. Physical findings were unclialigedl except that the tongue lia(l become beefy red!. A blood count revealed: hemoglobimi 12.1 Gm. per cent, \\‘BC 10,300 cu.nimii., with PMN 93 per cent, lymphocytes 5 per cent, and monocytes 2 per cent. A platelet couint was not done at that time. Bleeding timmie was 1 muinumte and 15 secomlds, clottimig time 3 minutes amid 20 seonds. X-ray exanunatiomi of the umpper gastrointestinal tract was negative. The next day bleeding from the gums and! nose began and large henlatomi as developed at time sites of injections. Review of the numrses’ miotes revealed tile previoumsly UlimlOtiCe(l large dose of clilorainphemucol. On November 18, 1957, the omie-stage prothromiibimi tImlle was 10 per cent of normual. The mlext day the hemoglobin valime was 9.4 Gm. pc m Cemlt, and the platelet count was 75,000,cu.mm.#{176} Serial blood coumits are shown in table 1. Results of liver fuinction stumd!ies were witiliml mlorliial limits except for a 4+ cephalin floccumiation after 48 hours. A direct Coombs’ test was negative. The patient was given 50 mg. of vitamiiin K, oxide imitravemiously with aimuost inimiicdiate cessatiomi of all bleeding. A bone marrow aspiration performed on November 20, 1957,