Medical Hypotheses and Research

OBJECTIVE: To review the literature concerning idiosyncratic drug-induced agranulocytosis, a rare but life-threatening potential adverse event of most drugs. DATA SOURCES: Articles were identified through searches of MEDLINE (January 1966 to March 2005). Unpublished data from our cohort of drug-induced agranulocytosis in the University Hospital of Strasbourg, France were also considered. DATA EXTRACTION AND SYNTHESIS: All of the papers and abstracts were reviewed by at least two senior researchers that selected the data used in the study. The incidence of idiosyncratic drug-induced agranulocytosis remains stable in the past twenty years: 2.4 to 15.4 cases per million, despite the emergence of new causative drugs, mainly antibiotics, antiplatelet agents and antithyroid drugs. To date, druginduced agranulocytosis remains a serious adverse event due to the frequency of severe sepsis with severe deep infections (such as pneumonia), septicemia and septic shock in around 2/3 of patients. In this setting, old age (>65 years), septicemia or shock, metabolic disorders such as renal failure, and a neutrophil count below 0.1 x 10/L are poor prognostic factors. Nevertheless, with the aid of appropriate management using pre-established procedures, intravenous broad-spectrum antibiotic therapy and hematopoietic growth factors, the mortality rate is currently ~5%. CONCLUSIONS: Given the increased life expectancy and subsequent longer exposure to drugs, as well as the development of new agents, health care professionals should be aware of the adverse event associated with idiosyncratic drug-induced agranulocytosis as well as its management. R E V IE W *ADDRESS ALL CORRESPONDENCE TO: DR. E. ANDRÈS, SERVICE DE MÉDECINE INTERNE, CLINIQUE MÉDICALE B, HÔPITAUX UNIVERSITAIRES DE STRASBOURG, 1 PORTE DE L’HÔPITAL, 67 091 STRASBOURG CEDEX, FRANCE. PHONE: 33-3-88-11-50-66. FAX: 33-3-88-11-62-62. E-MAIL: [email protected] ● M E D IC A L H Y PO T H E SE S A N D R E SE A R C H ● T H E JO U R N A L FO R IN N O V A TI V E ID EA S IN B IO M ED IC A L R ES EA R C H ● E. ANDRÈS, ET AL. 516