Diclofenac
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Neutropenia leading to ecthyma (first report) in an elderly patient: case report A 66-year-old man developed neutropenia, which led to ecthyma gangrenosum, during treatment with diclofenac. The man, who had been receiving diclofenac [dosage, therapeutic indication and duration of treatment before reaction onset not stated], presented with a 1-week history of painful lesions in his right axilla and his suprapubic area. He was lethargic, anorexic and generally unwell. He had received oral flucloxacillin for 3 days before urgent examination in the dermatology department. Examination showed gross oedema in his suprapubic area accompanied by a 2cm central eschar with surrounding erythema. A smaller necrotic area was present in his right axilla. His WBC count was 2.3 × 109/L and his neutrophil count was 0.9 × 109/L. He was diagnosed with ecthyma gangrenosum, and multiple subsequent swabs of his affected areas confirmed the presence of Pseudomonas aeruginosa. The man’s suprapubic eschar was debrided and he received IV gentamicin and flucloxacillin; diclofenac was stopped. Within 5 days, his neutropenia had resolved and he improved dramatically. He was discharged 7 days after admission, and after 4 weeks, his lesions were fully healed with minimal scarring. Author comment: "[I]t is hypothesized that diclofenac caused a neutropenia in this patient leading to Pseudomonas infection." Fairhurst DA, et al. Ecthyma gangrenosum presenting in diclofenac induced neutropenia. Journal of the European Academy of Dermatology and Venereology 801044164 20: 868-869, No. 7, Aug 2006 - England
» Editorial comment: A search of AdisBase and Medline did not reveal any previous case reports of ecthyma associated with diclofenac. The WHO Adverse Drug Reactions database contained nine reports of bacterial infection associated with diclofenac.
0114-9954/10/1119-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 16 Sep 2006 No. 1119
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