IV N-acetylcysteine treatment of hematologic reactions to chrysotherapy

Twelve patients with adverse hematologic reactions to chrysotherapy received intravenous N-acetylcysteine (IV NAC) to achieve removal and/or redistribution of gold. Urine gold excretion while on IV NAC doubled that predicted from control measurements. Treatment within 20 days of the last gold injection was associated with better recovery of hematologic parameters. No untoward reactions from IV NAC were encountered. The pathogenesis of gold induced hematologic reactions is examined from both toxic as well as immunological perspectives.