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Life-Threatening Idiosyncratic Drug-Induced Agranulocytosis in Elderly Patients

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Abstract

Agranulocytosis is a life-threatening disorder in any age, but particularly so in elderly patients who are receiving, on average, a larger number of drugs than younger patients. Drug-induced agranulocytosis still remains a rare event, with an annual incidence rate of approximately 3–12 cases per million population. This disorder frequently occurs as an adverse reaction to drugs, particularly antibacterials, antiplatelet agents, antithyroid drugs, antipsychotics or antiepileptic drugs, and NSAIDs. Although patients experiencing drug-induced agranulocytosis may initially be asymptomatic, the severity of the neutropenia usually translates into the onset of severe sepsis that requires intravenous broad-spectrum antibacterial therapy. In this setting, haematopoietic growth factors have been shown to shorten the duration of neutropenia. Thus, with appropriate management, the mortality rate of idiosyncratic drug-induced agranulocytosis is now 5–10%. However, given the increased life expectancy and subsequent longer exposure to drugs, as well as the development of new agents, physicians should be aware of this complication and its management.

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Acknowledgements

We are indebted to Lyssa Krabbenhoft, who kindly edited the English of the text.

Practitioners of the study group of drug-induced agranulocytosis in the Hôpitaux Universitaires de Strasbourg included: M. Alt, Department of Hypertension, Center of Pharmacovigilance d’Alsace; G. Kaltenbach and C. Martin-Hunyadi, Department of Internal Medicine and Geriatrics; E. Andrès, N. Henoun Loukili and E. Noel, Department of Internal Medicine B; J.C. Weber, Department of Internal Medicine A; J.E. Kurtz and F. Maloisel, Department of Oncology-Hematology; and J. Sibilia, Department of Rheumatology.

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

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Authors and Affiliations

  1. Department of Internal Medicine, Hôpitaux Universitaires of Strasbourg, Strasbourg, France

    Emmanuel Andrès, Esther Noel & Nourredine Henoun Loukili

  2. Department of Oncology-Hematology, Hôpitaux Universitaires of Strasbourg, 1 Porte de l’Hôpital, 67 091, Strasbourg, Cedex, France

    Jean-Emmanuel Kurtz &  Frédéric Maloisel

  3. Department of Internal Medicine and Geriatrics, Hôpitaux Universitaires of Strasbourg, Strasbourg, France

    Georges Kaltenbach

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  1. Emmanuel Andrès
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  2. Esther Noel
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  3. Jean-Emmanuel Kurtz
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  4. Nourredine Henoun Loukili
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  5. Georges Kaltenbach
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  6. Frédéric Maloisel
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Correspondence to Emmanuel Andrès or Frédéric Maloisel.

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Andrès, E., Noel, E., Kurtz, JE. et al. Life-Threatening Idiosyncratic Drug-Induced Agranulocytosis in Elderly Patients. Drugs Aging 21, 427–435 (2004). https://doi.org/10.2165/00002512-200421070-00002

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