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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
Summary
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.