43-year-old woman was dmitted to the Department of Internal Medicine, Sevarnce
Hospital because of fever and sore throat, developed after receiving arylthiouracil,
phenylephrine hydrochloride and chlorpheniramine maleate for rhinitis last 2 weeks. Physical
examination revealed markedly enlarged, hyperemic tonsils with whitish exudates. The total
blood leukocyte count was 800/mm^3, with 100% lymphocytes. The hemoglobin was 9.5 g/dl,
hematocrit 29.5% and platelet 224,000/mm^3. A bone marrow examination revealed no
myeloid cells, but erythroid and megakaryocytic series were normal. The cellularity was
moderately decreased. Although the patient was treated with the appropriate broad-spectrum
antibiotics, the patient was persistently and severly ill with granulocytes less than 50/mm^3
continuously. On the fourth day of hospitalization, we decided to administer
granulocyte-macrophage colonystimulating factor (GM-CSF; Schering-Plough/Sandoz).
Three days after the administration of 3 ug/kg GM-CSF daily subcutaneously, the leukocytes
were increased from 700/mm^3 to 2,900/mm^3; granulocytes from 56/mm^3 to 1,800/mm^3.
GM-CSF was given daily for 6 days, and it was discontinued when the leukocyte count
reached 13,400/mm^3 with neutrophil count of 11,390/mm^3. Follow-up bone marrow
examination revealed marked panmyeloid hyperplasia with left-shift and increased cellularity.
After discontinuing treatment, granulocytes gradually returned to normal. The patient
recorvered completely without any adverse effect during the treatment.
We assume that the rapid recovery of granulocytes was attributable to GM-CSF, and was
suggest that GM-CSF should be tried in patients with drug-induced agranulocytosis with
depletion of myeloid precursors in the hypocellular bone marrow.
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