咽頭痛を主訴に来院した無顆粒球症の1例 [in Japanese] A case of agranulocytosis associated with a sore throat [in Japanese]
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咽頭痛, 発熱を主訴に, 20歳の男性が当院を受診した.インフルエンザと診断され他院で, 1週間にわたり6種類の抗生剤と4種類の解熱鎮痛剤等による治療を受けたが38から39度の発熱が持続し, 摂食障害も出現するようになった.初診時には, 38.3℃ の発熱と急性扁桃炎, 重度の歯肉炎を認めた.現病歴と血液検査より薬物性の無顆粒球症と診断した.白血球数1100/ulに対しリンパ球79%, 好中球0%という結果であった.<BR>同日, 緊急入院のうえ感染予防のため隔離し, 原因と思われる薬剤の中止, 抗生剤の変更, γ-グロブリン, G-CSFによる治療を開始した.第5病日には白血球の増加を認め, 咽頭痛も改善した.その後も順調に経過し第17病日に退院した.<BR>局所所見では口腔咽頭粘膜や口蓋扁桃の壊死性潰瘍病変が特徴的とされているが, 本症例では潰瘍性病変は認められなかった.<BR>薬剤投与中には, 常に本病態の存在を疑い血液検査を行うことが重要と考える.
A 20-year-old man came to our hospital with complaints of a sore throat and high fever. He had been treated for influenza for one week at another clinic. He had received six antibiotics, four antipyrines, and other drugs. High body temperature of 38 to 39°C had continued and swallowing became difficulty. At the first examination, he had a fever of 38.3°C, tonsilitis and severe gingivitis. History and laboratary data led to a diagnosis of drug-induced agranulocytosis.<BR>Blood examination revealed a white blood cell count of 1, 100/ul with 79% lymphocytes, but no neutrophils. On the same day, he was admitted to our hospital. The drugs suspected of inducing agranulocytosis were discontinued immediately. He was isolated to prevent bacterial and fungal infections. He was treated with broad-spectrum antibiotics, G-CSF, and administration of γ-globuhn. On the 5th day, the white blood cell counts became normal and the symptoms of sore throat had marked improvement. He recovered from agranulocytosis and was discharged on the 17th day with a normal blood count. Previous reports says that antibiotics and antipyretics/analgesics together acount for about 70% of all cases of drug-induced agranulocytosis. In this case, more than 10 drugs were administered, and estimation of the reponsible drug was impossible. There are aiso various tests for identifying the reponsible drug, but none was performed because of their low specificity or sensitivity and inadequate reproducibility. It is generally said that necrotic ulcers in the oral cavity, pharynx, or tonsils are observed agranulocytosis. Our patient had no ulcer lesions, but he did have tonsilitis and severe gingivitis. Blood examination is important in patients with tonsilitis or gingivitis during treatment with medication.
Stomato-pharyngology 13(3), 401-406, 2001-06-01
Japan Society of Stomato-pharyngology