Dipyrone
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Dipyrone Acute haemolytic crisis: case report
An 8-month-old boy developed acute haemolytic crisis during treatment with dipyrone. The boy, who had a history of glucose-6-phosphate dehydrogenase deficiency, presented to hospital in Singapore for a suspected leukaemia. One week before presentation, he was suffering from fever of unknown source, for which, he was admitted to a local hospital. From day 1, he was prescribed with multiple antibiotics included amoxicillin, cefotaxime and meropenem, and antipyretics included IV, oral and suppository paracetamol and dipyrone [metamizole; dosage not stated]. However, no improvement was observed. On day 6, complete blood count revealed a decreased level of haemoglobin and platelet count, and increased level white blood cell count, with immature cells reported on a blood smear. On presentation, he was found to be pale and jaundiced, and had a palpable liver edge and splenic tip. No rash was observed. Complete blood count showed a decreased level of haemoglobin, and an increased level of white blood cell and platelet count. Bilirubin, ALT and AST level were also found to be elevated. Peripheral blood smear showed occasional blasts, leucoerythroblastosis, haemophagocytosis and hemi-ghost red cells. Bone marrow aspiration revealed haemophagocytosis with a background of normal haemopoiesis. Serological tests were positive for dengue IgM and NS1 antigen. A diagnosis of dengue fever with dipyrone-induced acute haemolytic crisis associated with G6PD deficiency was made. The boy’s treatment with dipyrone and other antibiotics were discontinued, and he was treated with red cell transfusion. He recovered completely, and no recurrence was noted on a follow-up after 2 years. Lee AC-W. Peripheral and bone marrow hemophagocytosis in dengue fever. Pediatrics and Neonatology 61: 556-557, No. 5, Oct 2020. Available from: URL: http:// doi.org/10.1016/j.pedneo.2020.05.005
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Reactions 12 Dec 2020 No. 1834
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