Desipramine

Massive eosinophilia Eosinophilic reactions to tricyclic antidepressants usually mvolve a 2-fold increase in eosinophils, but a 52-year-old man on desipramine 200mg/day developed a clinically significant neutropenia when his eosinophilia reached 81 % of a total leukocyte count of 19,0001 mm J. He had previously taken many diff~rent medications with no allergic responses other than a presynCopal reaction to the dye (iodide) used in an IV pyelogram. He was taking stool softeners, IV acetaminophen and flurazepam He1 for night sedation when he started taking desipramine. Acetaminophen and flurazepam were stopped at this time. After I month on desipramine the patient complained of abdominal discomfort and diarrhea, which did not respond to conservative treatment with a liquid diet, kaolin-pectin mixture and 'Lomoti!' (diphenoxylate Hel + atropine sulphate + codeine sulphate). His leukocyte count rose to 14,000/mm1 with 19% eosinophils. The usual chemjca.J and enzyme studies plus multiple stool analyses were unremarkable, and he had no rash or fever. Bone marrow showed an increase in eosinophil Precursors, with no evidence of leukemic cells; megakaryocytes were normal, but all other marrow elements were depressed. Two weeks after the onset of eosinophilia his neutrophil count was 23001 mmJ

, total leukocytes 16, I 001 mm l and 74% eosinophils. IgE was raised. Neutrophils ftnallyfellto 1520/mml, 'All evidence pointed 10 an ai/ergic reaction, with desipramine the most likely antigen,' When this drug was ~topped. he recovered while taking nortriptyline ( I OOmg/ day) and within 2 weeks all blood values were normal. Jones. DR and Maloney, T.R: American Journal of Psychiatry 137: 115 (Jan 1980)

4 Reactions 7 Mar 1980 0157-7271/8010307-0004/0$00.5010 ~ ADISPress