Severe Sepsis Due to Cervical Abscess After Agranulocytosis Associated With Metamizole (original) (raw)
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Metamizole Related Granulocytopenia and Agranulocytosis: An Analysis of 13 Children
Journal of Turgut Ozal Medical Center, 2015
Objectives: Metamizole sodium (Novalgin ® ) is an effective, widely used analgesic and antipyretic agent in several countries. In spite of its availability and common usage, it has serious and potentially fatal adverse effects like agranulocytosis and aplastic anemia. Objectives of this study are to evaluate incidence, severity, and clinical significance of metamizole related neutropenia and agranulocytosis, and to study recovery duration of neutropenia and agranulocytosis in children exposed to metamizole. Material and Methods: Thirteen cases of neutropenia and/or agranulocytosis secondary to metamizole usage have been evaluated retrospectively. Duration and cumulative doses of metamizole, degree of neutropenia, recovery from neutropenia, and other complications related to neutropenia were evaluated. Results: Overall, thirteen granulocytopenic patients were recorded for 12 months after metamizol usage. Mean metamizole exposure duration was 4,64 (2-7) days; mean daily total metamizo...
Idiosyncratic drug-induced agranulocytosis: Update of an old disorder
European Journal of Internal Medicine, 2006
In this paper, we review the literature on idiosyncratic drug-induced agranulocytosis, a rare but life-threatening potential adverse event of most drugs. Articles were identified through MEDLINE searches (1966-2005). Additional references were localized through a review of textbooks on hematology and internal medicine, and information gleaned from international meetings. Additional unpublished data from our cohort with drug-induced agranulocytosis at the University Hospital of Strasbourg, France, were also considered. Searches were done using the following key words: "agranulocytosis", "drug-induced agranulocytosis", and "idiosyncratic agranulocytosis" and were restricted to: English-and French-language, human subjects, clinical trial, review, and guidelines. All of the papers and abstracts were reviewed by at least two senior researchers who selected the data used in the study. What we found is that, over the last 20 years, the incidence of idiosyncratic drug-induced agranulocytosis has remained stable-2.4-15.4 cases per milliondespite 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 about two-thirds of all patients. In this setting, old age (N 65 years), septicemia or shock, metabolic disorders such as renal failure, and a neutrophil count below 0.1 × 10 9 /L are poor prognostic factors. Nevertheless, with appropriate management using pre-established procedures, with intravenous broad-spectrum antibiotic therapy, and hematopoietic growth factors, the mortality rate is currently around 5%. 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 this adverse event and its management.
Metamizole: A Review Profile of a Well-Known “Forgotten” Drug. Part II: Clinical Profile
Biotechnology & Biotechnological Equipment, 2013
Metamizole, a nonnarcotic analgesic, has been used to treat pain and fever for almost 90 years in some countries, while in others it is completely unknown or forgotten. It was synthesized by the German company Hoechst AG in 1920, and its mass production started in 1922. Metamizole remained freely available worldwide until the 1970s, when it was found that the drug poses a risk of causing agranulocytosis. Soon after that, metamizole was banned in the United States, Japan, Australia, and part of the European Union. However it is still widely used in some European countries, Turkey, Israel, India, Brazil, and Third World countries. Metamizole is available over-the-counter and remains one of the most popular analgesics in Bulgaria. The objective of this study is to review the pharmaceutical and pharmaco-toxicological aspects of the drug. In Part II, the clinical profile of the drug will be discussed.
Agranulocytosis Induced by Vancomycin. Case Report and Literature Review
The American journal of case reports, 2018
BACKGROUND Vancomycin has been used for decades to treat infections by Gram-positive bacteria, particularly those caused by methicillin-resistant staphylococci. Agranulocytosis is an infrequent complication of this antibiotic, postulated in its genesis a mechanism immune-mediated by antineutrophil antibodies and antineutrophil cytoplasm antibodies (ANCA). Treatment includes discontinuing vancomycin, and granulocyte colony-stimulating factor administration. CASE REPORT We present the case of a patient who developed agranulocytosis secondary to vancomycin during the treatment of an infectious endocarditis, which was reversed when the antibiotic was stopped. Concomitantly to neutropenia, he had ANCA positivity, which subsequently became negative. CONCLUSIONS Agranulocytosis induced by vancomycin is infrequent and generally occurs after day 12 of treatment. In most cases, like in our case, it is caused by an immune-mediated mechanism. More studies are needed to determine the pathogenic ...
Cureus
This article has been corrected at the request of the author due to presence of an error in the Discussion section which was noticed by a reader. The second sentence of the first paragraph in the Discussion section has been corrected as the original version incorrectly referred to "side effects", when in reality they are "clinical features". Original (incorrect): The common side effects of carbimazole include fever (92%), sore throat (85%), painful mouth ulcer (15%), ulcer (8%), and reduced immune response making individuals prone to infections [3]. Corrected: The common clinical features of carbimazole induced agranulocytosis include fever (92%), sore throat (85%), painful mouth ulcer (15%), ulcer (8%), and reduced immune response making individuals prone to infections [3].
2020
Metronidazole is a commonly used drug and considered relatively safe. But it may present with neurotoxicity, commonly peripheral and rarely central. We report here a case of a young patient with amoebic liver abscess who continued taking metronidazole longer than the prescribed duration of the drug and developed peripheral neuropathy and cerebellar neurotoxicity which was reversible after discontinuation of the drug.
Agranulocytosis associated with dipyrone (metamizol)
European journal of clinical pharmacology, 2005
Reported estimates of the risk of agranulocytosis associated with metamizol have varied by several orders of magnitude. We assessed this association in a large database for the surveillance of blood dyscrasias. Since 1980, all laboratory units of haematology in a defined area (3.3-4.1x10(6) inhabitants) contribute to the ascertainment of all cases of agranulocytosis meeting strict diagnostic criteria. These cases of patients with agranulocytosis and sex-, age-, hospital- and date-matched controls were interviewed using a structured questionnaire about previous drug exposures, and relative risks were calculated for several categories of exposure to metamizol. After a total follow-up of 78.73x10(6) person-years, 273 community cases of agranulocytosis had been found--of which 96 were excluded for various reasons and 177 were included in the case-control analysis--and were compared with 586 matched controls. Thirty cases of agranulocytosis (16.9%) and nine controls (1.5%) had been expos...
European Journal of Clinical Pharmacology, 2015
Purpose In 1986, the risk of agranulocytosis prompted German authorities to restrict the indications for metamizole use. After an initial decline, prescriptions increased from <20 million defined daily doses in 1990 to >140 million in 2012. Concurrently, spontaneous reports of agranulocytosis increased from about 10 in 1990 to >50 in 2012. In this study, reports were analyzed to identify targets for risk minimization measures. Methods Reports of suspected metamizole-induced agranulocytosis (neutrophils <0.5×10 9 cells/l) between 1990 and 2012 were identified in the German spontaneous reporting database. Cases for which original reporting documents were available were eligible for analysis. Patient characteristics, indication, clinical course, and outcome were assessed. Results One hundred sixty-one reports were analyzed. The mean age of the patients was 56.8 years (11-93) and 64.6 % were female. Off-label use was identified in about 25 % of cases. Neutrophils fell below 100/μl in 63 and intercurrent infections developed in 109 cases. Thirty-eight patients (23.6 %) died. In two thirds of the cases, agranulocytosis occurred within 6 weeks of permanent or intermittent metamizole treatment, in 30.5 % within 7 days, including 18 cases of immediate onset after the first or second administration. Conclusion The reported cases show severe clinical courses and are, to some extent, a result of off-label use. Due to the absence of individual risk factors and presence of variable onset patterns, risk minimization measures should focus on restricting use to defined clinical situations and providing concise risk information for patients and healthcare professionals.
Agranulocytosis: A Rare Complication and Management Paradox
Open Access Journal of Endocrinology, 2018
Introduction: Thyroid disorders are common disorders seen around the globe. The prevalence of thyroid disorders in India is approximately 5-10%, more common in females and hypothyroidism being more common than hypothyroidism followed by hyperthyroidism. Anti-thyroid drugs are commonly used for the medical management of hyperthyroidism. A rare and notoriously dangerous complication of these drugs is agranulocytosis, seen in 0.3-0.5% of treated patients. Case: A 50 year old female presented in the emergency department with high grade fever associated with rigors and severe throat paint associated with difficult and painful swallowing since 5 days. She was a known case of hyperthyroidism on carbimazole 30 mg once daily since 1 year. Patient was vitally stable and throat examination showed severely enlarged and inflamed tonsils with inflamed posterior pharyngeal. ENT opinion was taken which advised for conservative management and elective tonsillectomy later. The entire fever profile was negative. Her total leucocyte count was 650 cells/mm 3. Carbimazole induced agranulocytosis was suspected and the drug was withheld. Gradually the WBC count started to rise and patient recovered symptomatically. Conclusion: Agranulocytosis is a potentially lethal side effect but if diagnosed early is treatable. High index of suspicion and timely drug withdrawal is the key to reduce morbidity and mortality.