A granulocytosis associated with rufinamide: A case report

Area of Science:

• Neurology
• Pharmacology
• Hematology

Background:

• Rufinamide is a novel antiepileptic drug (AED) with a unique chemical structure.
• Previous studies reported a low incidence of leukopenia with rufinamide, with no documented cases of agranulocytosis.
• Lennox-Gastaut syndrome (LGS) is a severe form of epilepsy often requiring multiple antiepileptic medications.

Observation:

• A 10-year-old boy with LGS developed agranulocytosis 18 days after starting rufinamide as add-on therapy.
• The patient presented with high fever and a skin rash, symptoms that resolved upon rufinamide discontinuation.
• Bone marrow examination revealed normocellular marrow with a selective decrease in mature myeloid cells, ruling out malignancy or severe infection.

Findings:

• This case represents the first reported instance of agranulocytosis potentially induced by rufinamide.
• The adverse event was directly linked to rufinamide administration and resolved after its withdrawal.
• The findings suggest a possible causal relationship between rufinamide and agranulocytosis.

Implications:

• Rufinamide may pose a risk of inducing agranulocytosis, a potentially life-threatening condition.
• Clinical monitoring for signs of agranulocytosis in patients treated with rufinamide is crucial.
• Routine blood count monitoring should be considered for early detection of this adverse effect.