Reactions 1704, p366 - 2 Jun 2018
Agranulocytosis and drug-induced hypersensitivity
syndrome: case report
A 68-year-old woman developed voriconazole-induced
hypersensitivity syndrome (DIHS) and agranulocytosis during
treatment with voriconazole for pulmonary aspergillosis [route
and dosage not stated; not all durations of treatment to
reaction onsets and outcomes stated].
The woman, who had pulmonary aspergillosis, received
voriconazole for 1 month. After 1 month, she suddenly
developed high-grade fever, generalised rash and mild facial
oedema and then visited to a hospital. She had a history of
hypertension, nail lichen planus and hyperlipidaemia.
The woman’s voriconazole therapy was discontinued.
Despite voriconazole withdrawal for 1 week, at the second
visit, the rash developed over the entire body along with
exaggeration of facial oedema. The body temperature was
39.8°C. Pruritic erythema and purpura with scratching marks
on her body were noted in addition to cervical, axillary and
inguinal lymphadenopathy. Skin histology demonstrated mild
liquefaction and lymphocytic infiltration with eosinophils
around blood vessels. The laboratory findings revealed a
drastic reduction in the WBC accompanied by agranulocytosis.
Increased levels of AST and CRP were observed along with
significant high serum levels of thymus and activation-
regulated chemokine and soluble interleukin-2 receptor. The
skin manifestation was highly suggestive of DIHS requiring
hospitalisation. She was treated with prednisolone,
meropenem and unspecified granulocyte-colony stimulating
factor. Seven days after these treatments, her rash and fever
disappeared completely. She also received treatment with
piperacillin and tazobactam. The lymphocyte stimulation test
with voriconazole described a significant proliferative
response, suggesting that voriconazole was the culprit.
Author comment: "[W]e report severe agranulocytosis in a
patient with DIHS induced by voriconazole."
Kaneko Y, et al. Agranulocytosis associated with voriconazole-induced
hypersensitivity syndrome. Journal of Dermatology 45: e118-e119, No. 5, May
2018. Available from: URL: http://doi.org/10.1111/1346-8138.14142 -
Reactions 2 Jun 2018 No. 17040114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved