1/7. agranulocytosis possibly caused by ranitidine in a patient with renal failure.A 70-year-old Japanese woman with renal dysfunction under hemodialysis presented with vomiting and chill with fever. Over the previous 24 weeks she had been taking 75 mg of ranitidine after hemodialysis. Other medications taken were prednisolone, furosemide, alpha-calcidol, amlodipine and calcium carbonate. Before starting ranitidine, she had been treated with famotidine for about 2 years without complication. Hematological inspection on admission revealed agranulocytosis with WBC of 400/mm3. ranitidine was discontinued and granulocyte colony-stimulating factor (G-CSF) was started. On Day 3, laboratory data showed slight improvement of cytopenia with WBC of 1,000/mm3. On Day 6, her hemogram showed marked improvement with WBC of 11,700/mm3 and G-CSF was discontinued. She was discharged on Day 10. Several cases describing ranitidine-induced cytopenia are associated with the use of ranitidine at a dose of 150 mg/day or higher, and adverse reactions were found within 2-35 days after beginning ranitidine treatment. In the case described here, however, the adverse reaction occurred after a longer treatment period with ranitidine at a lower dose. In conclusion, ranitidine should be administered with great caution to patients with severe renal dysfunction.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
2/7. Cyclic neutropenia: a case of asymptomatic appendicitis.A seven year old boy with a history of cyclic neutropenia (CN) was admitted to the hospital after developing fever and chills following a bicycle accident. After admission, he had a rapidly deteriorating hospital course leading to shock and death. At autopsy, acute appendicitis with resultant peritonitis and sepsis was diagnosed. The peculiar clinical and microscopic aspects of this case will be presented and contrasted with the more usual signs and symptoms of this cyclic disease.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
3/7. agranulocytosis associated with sulfasalazine.agranulocytosis is a rare but potentially lethal adverse effect of sulfasalazine. We report a case of sulfasalazine-associated agranulocytosis that occurred in a 79-year-old woman who had been taking the drug for approximately seven weeks. The patient had discontinued the drug on her own initiative nine days prior to admission. The patient was admitted with complaints of hoarseness, fever, odynophagia, and malaise. The total white blood cell count was 600/mm3 with a differential of 0% neutrophils, 8% bands, 67% lymphocytes, and 25% monocytes; a bone marrow aspirate and biopsy revealed maturation arrest. The patient's peripheral white blood cell count and differential progressively increased over the nine-day hospital course. Upon discharge the white blood cell count was 12,000 cells/mm3 with 66% neutrophils, 8% bands, 16% lymphocytes, and 10% monocytes. Complete blood counts should be performed periodically in patients receiving sulfasalazine, especially during the first two months of therapy. pharmacists should counsel patients to discontinue the drug and consult their physician immediately if they develop unexplained fever, chills, sore throat, malaise, or other nonspecific illness during the initial two months of treatment.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
4/7. An anti-neutrophil antibody associated with a propylthiouracil-induced lupus-like syndrome.A 15-year-old woman with thyrotoxicosis controlled by propylthiouracil presented with chills, fever, splenomegaly, anemia, thrombocytopenia, leukopenia, hypergammaglobulinemia, immune complexes, a positive anti-nuclear antibody test, and a cellular marrow with normal maturation. Anti-neutrophil antibody was detected by cytotoxicity testing. The activity was restricted to the IgM fraction and was absorbed optimally at 4 degrees C. The antibody activity was recovered in both heat and ether eluates made from granulocytes. lymphocytes, platelets, and red blood cells failed to absorb reactivity. The antibody did not inhibit superoxide production or bacterial killing. propylthiouracil was discontinued and all signs and symptoms resolved.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
5/7. captopril-induced agranulocytosis: a case report.captopril 12.5 mg twice daily was initially administered given to a woman with chronic renal failure and hypertension. Three weeks later, she developed chills, high fever and sore throat. Hemogram showed severe neutropenia; the white cell count showed 600/cu mm; bone marrow aspirate and biopsy revealed a paucity of myeloid series. Antineutrophil antibody was not detected in the serum. The neutrophil counts returned to normal after captopril was discontinued two weeks later. We recommend that the peripheral white blood cell count in patients whom captopril is prescribed must be carefully monitored in the first three months, particularly in those with impaired renal function.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
6/7. methimazole-induced agranulocytosis treated with recombinant human granulocyte colony-stimulating factor (rhG-CSF): a case report.methimazole 5 mg three times daily was prescribed in 1994 spring to a woman, aged 53 years, with relapsed hyperthyroidism. The drug was discontinued six weeks after initiation because of leukopenia. Two weeks still later, the patient developed chills, high fever, and a sore throat. The leukocyte count was 1,100/mm3 with 23% granulocytes, 76% lymphocytes and 1% monocytes. The granulocyte count stopped decreasing only three weeks after the drug was discontinued when the recombinant human granulocyte colony-stimulating factor (rhG-CSF) was given; the patient recovered uneventfully. Thus we recommend that the peripheral leukocyte count of patients who receive methimazole therapy must be carefully monitored during the first three months. Furthermore, the use of rhG-CSF for methimazole-induced agranulocytosis abbreviates the period required for marrow recovery after cessation of this offensive drug.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
7/7. An uncommon cause of oral ulcers.A 25-year-old Hispanic woman presented with painful oral ulcers, a sore throat, and dysphagia of two weeks' duration. She was treated empirically with acyclovir for presumed herpes simplex stomatitis and esophagitis and sent home. A week later, she returned with complaints of worsening sore throat, fever (as high as 38.9 degrees C), and cough producing yellow-green sputum. She had not had chills, shortness of breath, burning on urination, or a change in bowel habits.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |