Reactions 484 - 15 Jan 1994

SDesipramine

Agranulocytosis: case reportAgranulocytosis developed in a 56-year-old woman 3

months after beginning desipramine 200 mg/day fordepression.

The patient developed symptoms of an upper respiratorytract infection and 5 days later was admitted with a diagnosisof pneumonia and sepsis. Neutropenia was also diagnosed andher WBC count was 700/mm3. Desipramine was withdrawnand she was treated with broad spectrum antibacterials. After1 week, there appeared to be some evidence of recovery asWBC count was 2600/mm3.

However, 5 days later WBC count reached 77 000/mm3 andthe patient developed respiratory distress requiring intubation.Treatment with ketoconazole was started after histoplasmosiswas detected and the patient gradually improved, eventuallymaking a complete recovery.

Author comment: This case highlights that agranulocytosiscan occur later than has been previously reported with tricyclicantidepressants. Marked leukocytosis, which may be lifethreatening, may occur in the recovery phase.Cabaniss DL, et al. Late onset tricyclic-induced agranulocytosis with an atypicalcourse. Pharmacopsychiatry 26: 130-131, Jul 1993 - USA 800239373

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Reactions 15 Jan 1994 No. 4840114-9954/10/0484-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved