Agranulocytosis induced by multidrug therapy in leprosy treatment: a case report

Silva, Itathiana Ma C B da; Oliveira, Caroline A P de; Guedes, Wilma R C de A; Oliveira, Benedito Bruno de; Oliveira, Doris Amorim Pontes de; Filho, Gilson Guedes de Araújo

doi:10.1590/s1413-86702009000200018

Cited by 8 publications

(16 citation statements)

References 3 publications

(5 reference statements)

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“…As in our patient, dapsone-induced agranulocytosis occurs after an average of 7 weeks of treatment and is defined by a neutrophil count below 0.5 × 10 9 /l [1]. Clinical signs include an infection with high fever, oral ulcers (with involvement of the tonsils), abscesses, pneumonia, and sepsis [13,17]. Our patient appears to be unusual in that he had severe neutropenia without related clinical symptoms, underscoring the need for routine laboratory testing for prompt diagnosis.…”

Section: Clinical Lettermentioning

confidence: 98%

“…If present, medication use must be stopped immediately [15]. Dapsone-induced agranulocytosis has been observed since dapsone was first introduced; with an incidence of 0.2-0.4 %, it is considered a rare side effect, with a potential fatality rate of 30 % [13,16,17]. As in our patient, dapsone-induced agranulocytosis occurs after an average of 7 weeks of treatment and is defined by a neutrophil count below 0.5 × 10 9 /l [1].…”

Section: Clinical Lettermentioning

confidence: 99%

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Asymptomatic dapsone‐induced agranulocytosis in a patient with chronic spontaneous urticaria

Milkova¹,

Hallermann²,

Simon³

et al. 2014

J Deutsche Derma Gesell

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Section: Clinical Lettermentioning

confidence: 98%

Section: Clinical Lettermentioning

confidence: 99%

Asymptomatic dapsone‐induced agranulocytosis in a patient with chronic spontaneous urticaria

Milkova¹,

Hallermann²,

Simon³

et al. 2014

J Deutsche Derma Gesell

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“…Insbesondere bei Auftreten von Fieber, einem Exanthem, Hepatitis und Lymphknotenschwellungen sollte außerdem an das Dapson-induzierte Hypersensitivitätssyndrom gedacht werden, was ein umgehendes Absetzen des Medikamentes erforderlich macht [15]. Die Dapson-induzierte Agranulozytose ist bereits seit den Anfängen des therapeutischen Einsatzes von Dapson bekannt und zählt bei einer Inzidenz von 0,2-0,4 % aller mit Dapson behandelten Patienten zu den seltenen unerwünschten Wirkungen mit einer potenziellen Letalität von 30 % [13,16,17]. Sie tritt wie bei unserem Patienten nach einer durchschnittlichen Therapiedauer von 7 Wochen auf und ist definiert durch Neutrophilenzahlen unter 0,5 × 10 9 /l [1].…”

Section: Clinical Letterunclassified

“…Infektionen mit enoralen Ulzerationen unter Mitbeteiligung der Tonsillen, Abszesse, Pneumonien oder septische Zustände vor [13,17]. Die bei unserem Patienten trotz der hochgradigen Neutropenie weitgehend fehlende Klinik erscheint ungewöhnlich und unterstreicht die Bedeutung regelmäßiger Laborkontrollen für eine frühzeitige Diagnosestellung.…”

Section: Clinical Letterunclassified

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Asymptomatische Dapson‐induzierte Agranulozytose bei einem Patienten mit chronisch spontaner Urtikaria

Milkova

Hallermann

Simon

et al. 2014

J Deutsche Derma Gesell

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Relações causais entre os antígenos de M. leprae (LAM E PGL-1) e os receptores TOLL-LIKE 1, 2 e seus efeitos na expressão de citocinas IFN-γ e IL-10 nas reações hansênicas

Antunes¹

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Background: The leprosy reactions are acute immunological events that occur before, during or after MDT of leprosy, being triggered mainly by interaction between the antigens of Mycobacterium leprae, PGL-1 and LAM, with the components of immunity of the host, such as, TLR1 and TLR2, that induce cells to produce cytokines related to control or bacillary dissemination. Objectives: The main goal of this research is establish causal relations between antigens of M. leprae (PGL-1 and LAM) and receptors, TLR1, TLR2 and their effects on cytokines expression, IFN-10, in leprosy reactions. Methods: Through ELISA serology it was possible measure the levels of anti-PGL-1 IgM and anti-LAM IgG, and with the use of the RT-qPCR proceeded the analysis of gene expression of TLR1 TLR2, IFN-10 using blood samples from 17 reactional patients and 17 nonreactional patients (Case-control study) that posteriorly were subdivided into 4 groups. For comparison between means of the variables, it resorted to use of analysis of variance (ANOVA) and about the degree of association between the variables, it has applied the correlation matrix. At the end, it was used the path analysis to verify the causal relation evolving antigens and toll-like receptors, whose the direct and indirect effects were the cytokines expression. Results: Among 34 patients, 76.4% (26/34) were MB and 23.6% PB, being that 100% (17/17) of reactional cases were MB and among the controls 53% (9/17). Analyzing the reactional group, 41.2% (7/17) suffered type 1 reaction, while 58.8% (10/17) presented type 2 reaction, emphasizing that, among patients with type 1 reaction, 57.1% (4/7) had reaction before treatment (downgrading), 14.2% (1/7) during and 28.8% (2/7) after MDT, whereas all patients of the type 2 reaction group, developed this occurrence after treatment. The levels of anti-PGl-1 have been elevated in type 1 and type 2 reactions with significant differences between means of these groups when compared to PB controls (F=6.42; p=0.002). Regarding to anti-LAM, this has been associated to type 2 reaction, group whose the means were higher than others, and this data showed significant differences as well (F=15.27; p<0.001). The reactional groups expressed higher levels of IL-10 (F=3.99; p=0,023), whereas the control group produced high levels of IFN-, especially the PB control (F=5.30; p=0.008). There were no differences in the levels of TLR1 and TLR2 expression in the comparison among groups. In the reactional group, the path analysis quantified the direct effects of anti-LAM (0.623) e anti-PGL-1 (0.605) on TLR2, which were higher than the residual effect of this model (0.255), indicating that these antigenic markers influenced only the TLR2 expression, which consequently correlated with the IL-10 expression in this group. An opposing mechanism occurred in the control group, insofar as it was found an immunological pathway that regulated the IFN-expression dependent on TLR1 and TLR2 association. Conclusion: In conclusion, path analysis allowed to demonstrate the causal r...

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Agranulocytosis induced by multidrug therapy in leprosy treatment: a case report

Cited by 8 publications

References 3 publications

Asymptomatic dapsone‐induced agranulocytosis in a patient with chronic spontaneous urticaria

Asymptomatic dapsone‐induced agranulocytosis in a patient with chronic spontaneous urticaria

Asymptomatische Dapson‐induzierte Agranulozytose bei einem Patienten mit chronisch spontaner Urtikaria

Relações causais entre os antígenos de M. leprae (LAM E PGL-1) e os receptores TOLL-LIKE 1, 2 e seus efeitos na expressão de citocinas IFN-γ e IL-10 nas reações hansênicas

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