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Ethosuximide induced agranulocytosis

Tadashi Imai1, Hitoshi Okada, Masanori Nanba

  • 1Department of Pediatrics, Kagawa Medical University, Ikenobe 1750-1, Miki, Kitagun, Kagawa 761-0793, Japan. taboimai@kms.ac.jp

Brain & Development
|September 18, 2003
PubMed

Insights

Agranulocytosis, a rare but serious side effect of ethosuximide, can be fatal if diagnosis is delayed. Early detection and intervention, like using granulocyte colony-stimulating factor, are crucial for survival in children.

Area of Science:

  • Pediatrics
  • Hematology
  • Pharmacology

Background:

  • Agranulocytosis is a rare but life-threatening adverse effect of certain medications.
  • Ethosuximide is an antiepileptic drug primarily used to treat absence seizures.
  • Prompt diagnosis and management of drug-induced agranulocytosis are critical to prevent fatal outcomes.

Observation:

  • A 16-month-old infant with Down syndrome developed fever and severe pneumonia 16 days after starting ethosuximide.
  • Initial blood tests revealed a significantly decreased leukocyte count (1700/microl) with an absence of granulocytes.
  • Bone marrow aspiration confirmed a lack of granulocyte production, indicating severe agranulocytosis.

Findings:

  • The patient required mechanical ventilation for pneumonia and developed disseminated intravascular coagulation.
  • Discontinuation of ethosuximide and administration of granulocyte colony-stimulating factor led to an increase in neutrophilic leukocytes.
  • A drug-induced lymphocyte stimulation test confirmed ethosuximide as the causative agent.

Implications:

  • This case highlights the potential for ethosuximide to cause severe agranulocytosis in children, even those with underlying conditions like Down syndrome.
  • The immunologic mechanism is suspected, emphasizing the need for vigilance regarding sudden onset of symptoms 1-2 weeks after drug initiation.
  • Early diagnosis, supported by tests like the drug-induced lymphocyte stimulation test, and prompt treatment are vital for patient survival.

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