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Agranulocytosis Associated With Yohimbine Use

Agranulocytosis Associated With Yohimbine Use Abstract Drug-induced agranulocytosis, outside cancer chemotherapy and industrial toxin exposure, is an infrequent condition that carries a high mortality rate and has an estimated annual incidence of 8.4 cases per million population per year.1 We report a unique case of agranulocytosis that developed after prolonged use of yohimbine. Report of a Case. A 69-year-old man with long-standing idiopathic impotence during 5 years of oral yohimbine therapy (5.4 mg three times a day) was admitted with a 3-week history of ataxia, frequent falls, and increasing spastic gait. His medical history revealed that in 1969 he had suffered a stroke syndrome with residual right-sided weakness. He was taking no medications other than yohimbine. His temperature on admission was 39°C, and his physical examination revealed that he had spastic quadriparesis. There was no clinical localization for the cause of fever. Laboratory tests revealed profound neutropenia (Table). The results of other laboratory studies, including References 1. Larregina A, Aggio MC, Alvarez RV. Incidence and probable etiology of toxic agranulocytosis in a definite population in the province of Buenos Aires (1963-1976) . Medicina. 1994;54:13-16. 2. Pisciotta AV, Santos AS. Studies on agranulocytosis, VI: the effect of clinical treatment with chlorpromazine on nucleic-acid synthesis of granulocyte precursors in normal persons . J Lab Clin Med. 1965;65:228-239. 3. Schut NH, Wiersinga WM, Van Oers MH. Methimazole-induced agranulocytosis preceded by transient granulocytopenia: a case report . Neth J Med. 1993;43:71-73. 4. Mason RP, Fischer V. Possible role of free radical formation in drug-induced agranulocytosis . Drug Saf. 1992;7( (suppl 1) ):45-50.Crossref 5. Parent-Massin DM, Sensebe L, Leglise MC, et al. Relevance of in vitro studies of drug-induced agranulocytosis: report of 14 cases . Drug Saf. 1993;9:463-469.Crossref 6. Feldman AM, Pepine CJ, Bristow MR, et al. Incidence of vesnarinone-induced neutropenia: the US experience . Circulation. 1993;88( (suppl 2) ): 1-301. Abstract. 7. Tajiri J, Noguchi S, Okamura S, et al. Granulocyte colony—stimulating factor treatment of antithyroid drug—induced granulocytopenia . Arch Intern Med. 1993;153:509-514.Crossref 8. Azuma J, Kurimoto T, Awata S, et al. Phase I study of KRN 8601 (rh G-CSF) in normal healthy volunteers: safety and pharmacokinetics in single subcutaneous administration . Rinsho lyaku . 1989;5:2231-2252. 9. Fukata S, Murakami Y, Kuma K, Sakane S, Ohsawa N, Sugawara M. G-CSF levels during spontaneous recovery from drug-induced agranulocytosis . Lancet. 1993;342:1495.Crossref 10. Julia A, Olona M, Revilla BE, et al. Drug-induced agranulocytosis: prognostic factors in a series of 168 episodes . Br J Hematol. 1991;79:366-371.Crossref 11. Physicians' Desk Reference. 49th ed. Montvale, NJ: Medical Economics Data Co; 1995:1813. 12. Young NS. Agranulocytosis. JAMA. 1994;271:935-938.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1996.00440100133016
Publisher site
See Article on Publisher Site

Abstract

Abstract Drug-induced agranulocytosis, outside cancer chemotherapy and industrial toxin exposure, is an infrequent condition that carries a high mortality rate and has an estimated annual incidence of 8.4 cases per million population per year.1 We report a unique case of agranulocytosis that developed after prolonged use of yohimbine. Report of a Case. A 69-year-old man with long-standing idiopathic impotence during 5 years of oral yohimbine therapy (5.4 mg three times a day) was admitted with a 3-week history of ataxia, frequent falls, and increasing spastic gait. His medical history revealed that in 1969 he had suffered a stroke syndrome with residual right-sided weakness. He was taking no medications other than yohimbine. His temperature on admission was 39°C, and his physical examination revealed that he had spastic quadriparesis. There was no clinical localization for the cause of fever. Laboratory tests revealed profound neutropenia (Table). The results of other laboratory studies, including References 1. Larregina A, Aggio MC, Alvarez RV. Incidence and probable etiology of toxic agranulocytosis in a definite population in the province of Buenos Aires (1963-1976) . Medicina. 1994;54:13-16. 2. Pisciotta AV, Santos AS. Studies on agranulocytosis, VI: the effect of clinical treatment with chlorpromazine on nucleic-acid synthesis of granulocyte precursors in normal persons . J Lab Clin Med. 1965;65:228-239. 3. Schut NH, Wiersinga WM, Van Oers MH. Methimazole-induced agranulocytosis preceded by transient granulocytopenia: a case report . Neth J Med. 1993;43:71-73. 4. Mason RP, Fischer V. Possible role of free radical formation in drug-induced agranulocytosis . Drug Saf. 1992;7( (suppl 1) ):45-50.Crossref 5. Parent-Massin DM, Sensebe L, Leglise MC, et al. Relevance of in vitro studies of drug-induced agranulocytosis: report of 14 cases . Drug Saf. 1993;9:463-469.Crossref 6. Feldman AM, Pepine CJ, Bristow MR, et al. Incidence of vesnarinone-induced neutropenia: the US experience . Circulation. 1993;88( (suppl 2) ): 1-301. Abstract. 7. Tajiri J, Noguchi S, Okamura S, et al. Granulocyte colony—stimulating factor treatment of antithyroid drug—induced granulocytopenia . Arch Intern Med. 1993;153:509-514.Crossref 8. Azuma J, Kurimoto T, Awata S, et al. Phase I study of KRN 8601 (rh G-CSF) in normal healthy volunteers: safety and pharmacokinetics in single subcutaneous administration . Rinsho lyaku . 1989;5:2231-2252. 9. Fukata S, Murakami Y, Kuma K, Sakane S, Ohsawa N, Sugawara M. G-CSF levels during spontaneous recovery from drug-induced agranulocytosis . Lancet. 1993;342:1495.Crossref 10. Julia A, Olona M, Revilla BE, et al. Drug-induced agranulocytosis: prognostic factors in a series of 168 episodes . Br J Hematol. 1991;79:366-371.Crossref 11. Physicians' Desk Reference. 49th ed. Montvale, NJ: Medical Economics Data Co; 1995:1813. 12. Young NS. Agranulocytosis. JAMA. 1994;271:935-938.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jun 10, 1996

References