pyrazolone and Neutropenia

A 4-year-old boy presented with fever, septic arthritis, and persistent neutropenia. Bone marrow biopsy revealed no evidence of neoplasia. Additional history disclosed that the patient had been given metamizole for pain before onset of his illness. Metamizole, a nonsteroidal antiinflammatory agent, is prohibited in the United States because of the risk of agranulocytosis but is widely used in Mexico and other countries. The increasing number of Latinos in the United States and the extensive cross-border transfer of medicines raise concerns that metamizole use and associated complications may become more frequent. After identification of the index patient, additional inquiry revealed that the patient's mother was hospitalized previously for overwhelming sepsis associated with metamizole use. These cases prompted an investigation of metamizole use in an urban pediatric clinic, which revealed that 35% of Spanish-speaking Latino families had used metamizole; 25% of these families had purchased the medication in the United States. We conclude that metamizole use is common and may be underrecognized in immigrant Latino patients. Physicians in the United States, especially those who practice primary care, hematology/oncology, and infectious diseases, must be aware of the availability and use of metamizole in specific patient populations and its potential for harmful side effects.

Topics: Agranulocytosis; Anti-Inflammatory Agents, Non-Steroidal; Child, Preschool; Dipyrone; Emigration and Immigration; Hispanic or Latino; Humans; Legislation, Drug; Male; Medicine, Traditional; Mexico; Neutropenia; Pain; Pyrazoles; Pyrazolones; Sepsis; United States

A case of pulmonary infection caused by Trichosporon beigelii is reported in an asthmatic patient undergoing steroid treatment who developed fever and lung infiltrates. Arthroconidia and blastoconidia were isolated from repeated sputum, bronchial aspirate and telescopic catheter samples. The infection coincided with neutropenia resulting from pyrazolone treatment. The response to amphotericin B treatment was favourable.

Topics: Agranulocytosis; Anti-Inflammatory Agents, Non-Steroidal; Asthma; Humans; Lung Diseases, Fungal; Male; Middle Aged; Neutropenia; Opportunistic Infections; Pneumonia; Prednisolone; Pyrazoles; Pyrazolones; Theophylline; Trichosporon

Data are presented demonstrating that bone marrow granulocytic cells from normal persons continuously proliferate and mature during 5 d of cultivation in a diffusion chamber system (DC). Bone marrow granulocytopoiesis in 3 patients with different granulocytopoietic disorders was investigated using DC. In patient 1, with drug-induced agranulocytosis, bone marrow aspirated on the "day of recovery" revealed intensive proliferation in DC resulting in a highly significant increase of mature granulocytes. Patient 2 suffered from chronic neutropenia of unknown aetiology. After 5 d cultivation of bone marrow in DC an increase of metamyelocytes was observed, indicating delayed maturation of granulocytic cells. Patient 3 had neutropenia probably due to the splenic sequestration. Data obtained with DC suggest stimulated granulocytopoiesis in this patient. The results obtained using DC reflect the particular phase of the disease in which bone marrow was aspirated. It may be concluded that this method could provide additional data in quantitative and functional disorders of granulocytes.

Topics: Adolescent; Adult; Agranulocytosis; Bone Marrow Diseases; Cells, Cultured; Evaluation Studies as Topic; Female; Hematologic Tests; Hematopoiesis; Humans; Hypersplenism; Methods; Middle Aged; Neutropenia; Pyrazoles; Pyrazolones