Mesalazine
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Neutropenia in an elderly patient: case report A 73-year-old man developed neutropenia during treatment with mesalazine for ulcerative colitis. The man started treatment with mesalazine [Asacol; dosage and route not stated] and itraconazole following a diagnosis of ulcerative colitis. Two weeks later, his WBC and absolute neutrophil counts were 15 000 and 12 405 cells/µL, respectively. He initially presented to his local physician with abdominal pain, fever and fatigue for 4 days; his WBC and absolute neutrophil counts had dropped to 600 and 180 cells/µL, respectively [duration of treatment to reaction onset not clearly stated]. He was admitted, and started treatment with antibacterials; neutropenia work-up was initiated. His active medication included propafenone, which was replaced with amiodarone on admission; however, his neutropenia continued to worsen. Hypocellular marrow was evident on bone marrow biopsy. At this point, approximately 5 months after treatment initiation, he was transferred with gram-negative sepsis and neutropenic fever; his absolute neutrophil count was zero. Treatment with antibacterials and amphotericin B was started. Mesalazine was withdrawn. On day 1, the man was haemodynamically stable; he remained afebrile and his condition improved throughout hospitalisation. Blood cultures were positive for Pseudomonas aeruginosa. At the time of discharge on day 4, his absolute neutrophil count was 44 cells/µL; he was told not to restart treatment with mesalazine. He had no complications or subsequent hospitalisations following discharge. At 4 months and 8 months post-hospitalisation, he had an absolute neutrophil count of 2275 and 3410 cells/µL, respectively. Fowler BT, et al. Asacol-induced neutropenia resolution without the use of granulocyte colony-stimulating factor. Southern Medical Journal 103: 1167-1169, No. 11, Nov 2010. Available from: URL: http://dx.doi.org/10.1097/ 803046691 smj.0b013e3181f46647 - USA
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Reactions 8 Jan 2011 No. 1333
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