1/7. Chronic neutropenia following gold therapy.We describe the first case of chronic neutropenia of 17 years' duration following gold therapy in a 53-year-old woman given a 1-g course of gold therapy in 1965 for treatment of seropositive rheumatoid arthritis. Although she had a good response to the gold therapy, her originally normal leukocyte count fell to 1.2 x 10(9)/L. Over the subsequent 17 years, she required multiple hospitalizations for recurrent skin, mouth, and respiratory tract infections. Serial leukocyte counts failed to show a cyclical nature to the chronic neutropenia. Normal results of a technetium Tc 99m spleen scan and lack of increased bone marrow leukocyte precursors rendered a diagnosis of Felty's syndrome unlikely. A bone marrow biopsy specimen revealed an isolated reduction in the number of myeloid precursors, which is consistent with gold-induced bone marrow toxicity. This patient's relative freedom from serious life-threatening infections remains enigmatic, but is undoubtedly related to her ability to augment another phagocytic cell line, and the remarkable phagocytic activity of her monocytes appears to have well compensated for her neutropenia. This activity was most likely responsible for her long-term survival.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/7. Stimulation of myelopoiesis in a patient with congenital neutropenia: biology and nature of response to recombinant human granulocyte-macrophage colony-stimulating factor.To stimulate granulopoiesis, we gave recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF; 120 microgram/m2/d) to a patient with congenital neutropenia. The treatment resulted in marked increases in white blood cell counts (maximum, 17,400/microL), consisting mainly of eosinophils (maximum, 13,050/microL) and monocytes (maximum, 1305/microL), rather than neutrophils (maximum, 798/microL). Circulating phagocytes (97% eosinophils) derived after GM-CSF treatment were less effective in chemotaxis, slower but equally effective in phagocytosis, and more effective in H2O2 production compared with normal control neutrophils, but comparable in chemotaxis and H2O2 production to control eosinophils. Before GM-CSF treatment, the bone marrow showed a maturation defect in the neutrophilic series that persisted after treatment despite marked increases in mature cells of other lineages. in vitro agar culture of bone marrow cells before GM-CSF treatment showed a normal number of granulocyte colonies; however, maturation was limited to the metamyelocyte stage. Although the absolute number and cycling rates of myeloid colony forming cells (predominantly eosinophils) increased after treatment, the maturation defect in the neutrophilic series persisted. The finding that GM-CSF induced stimulation of proliferation, which was coupled with maturation in the eosinophilic and monocytic but not the neutrophilic components, suggests that this patient had an intrinsic cellular or humoral defect in neutrophil maturation.- - - - - - - - - - ranking = 4keywords = nature (Clic here for more details about this article) |
3/7. Hepatic candidiasis in cancer patients: the evolving picture of the syndrome.Focal hepatosplenic candidiasis has been recognized with increasing frequency in recent years. We reviewed the cases of eight patients seen between 1982 and 1985, and information on 60 patients whose cases have been reported in the world literature. The characteristics of focal hepatosplenic candidiasis include persistent fever in a neutropenic patient whose leukocyte count is returning to normal, often coupled with abdominal pain; an elevated alkaline phosphatase level; and less commonly, rebound leukocytosis. The characteristic "bull's eye" lesions seen with hepatic ultrasound examination or computed tomography generally are not detectable until neutrophil recovery has occurred. diagnosis can be established only by biopsy evidence of yeasts or pseudohyphae in the granulomatous lesions. Cultures are frequently negative, however, especially in patients who have been pretreated with antifungal agents. We review the evolving nature of hepatosplenic candidiasis, focusing on diagnosis and treatment.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/7. amodiaquine-induced agranulocytosis: drug inhibition of myeloid colonies in the presence of patient's serum.We report a patient who developed agranulocytosis following exposure to three drugs: amodiaquine, pyrimethamine and dipyrone. The combination of amodiaquine with the patient's serum, obtained during the agranulocytosis, inhibited in vitro granulocyte-monocyte colony-forming unit (CFU-GM) growth of autologous and allogeneic marrow. These results support the view that amodiaquine-induced agranulocytosis is immune in nature. This in vitro approach may be used to study the mechanism of drug-induced agranulocytosis, especially when patients are exposed to multiple drugs.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/7. Proliferation of T gamma cells with killer-cell activity in two patients with neutropenia and recurrent infections.Two patients with severe granulocytopenia and recurrent infections of the skin and oropharynx had excess T lymphocytes with receptors for the Fc portion of IgG (T gamma cells) in blood and bone marrow. The abnormal T gamma cells killed antibody-sensitized target cells in vitro (killer-cell activity) but did not suppress immunoglobulin production by B lymphocytes (suppressor-cell activity). T gamma lymphocytes from normal persons showed both killer-cell activity and suppressor-cell activity. In the serum of one patient, granulocyte antibodies, possibly of an autoimmune nature, were detected. The clinical picture in conjunction with the hematologic and immunologic findings characterized the disease of both patients as a distinct entity among the chronic lymphoproliferative diseases of T-cell origin.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/7. Leucopenia as an adverse reaction to carbamazepine therapy.carbamazepine is a commonly used anticonvulsant agent, particularly in the management of partial seizures. Because of the low incidence of adverse effects associated with this drug, these are often ignored or forgotten. The cases of two patients in whom neutropenia has developed after prolonged therapy with carbamazepine, which illustrate the dose-related nature of this adverse reaction, are reported.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/7. Concurrent agranulocytosis and hepatitis secondary to clomipramine therapy.A 67-year-old man developed concurrent severe agranulocytosis and elevation of hepatic transaminases as a result of treatment with clomipramine. Although such adverse drug reactions can be considered rare events, the potentially serious nature of these reactions vindicate the routine monitoring of blood picture, and liver function tests, after initiation of treatment with tricyclic antidepressants.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |