Apomorphine
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Agranulocytosis: case report A 71-year-old woman developed agranulocytosis during treatment with apomorphine for Parkinson’s disease. The woman, who had been diagnosed with Parkinson’s disease, was admitted at the neurology department in December 2016 with movement disorders and severe motor fluctuations. At admission, she had been receiving antiparkinsonian treatment with rotigotine, levodopa and levodopa/carbidopa, along with various other drugs. Upon admission, she started receiving continuous SC infusion of apomorphine using minipump administered in the lower abdomen at an infusion rate of 2 mg/h over a 12h period per day. She had also approved for a boost dose of apomorphine 1mg bolus with the pump system when needed. Over 8 days, her apomorphine dose progressively increased until reaching a 5.5 mg/h. Subsequently, her motor fluctuations were reduced. She had well-tolerated apomorphine, except for diarrhoea. Her stool tests were normal. However, her biological follow-up tests revealed severe agranulocytosis, which was occurred 10 days after the initiation of apomorphine infusion. Fourteen days after the initiation of apomorphine, her neutrophil count decreased to 0.05 x109/L. Apomorphine was stopped on day 13. Fifteen days after the introduction of apomorphine, the woman developed severe lung infection and sepsis, which were successfully treated with unspecified antibacterials. On day 14, a bone marrow examination was performed, which showed morphological hypercellular, severe hypoplasia and contrasting with granulocyte precursors. Other causes for agranulocytosis were ruled out. After discontinuation of apomorphine, her diarrhoea stopped. She also received treatment with granulocyte-colony-stimulating-factors. Subsequently, her absolute neutrophil cell count became normal at day 22. Afterwards, her initial antiparkinsonian treatment was re-started at the same dose. Based on the findings, a diagnosis of apomorphine-induced agranulocytosis was confirmed. Conde S, et al. Subcutaneous apomorphine infusion in advanced idiopathic Parkinson’s disease and agranulocytosis: a case report. Parkinsonism and Related Disorders 78: 803501761 68-69, Sep 2020. Available from: URL: http://doi.org/10.1016/j.parkreldis.2020.07.012
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Reactions 19 Sep 2020 No. 1822
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