2 Antipsychotics, anticonvulsants, common cardiovascular agents, sulfa agents, penicillins, and antihistaminic agents are among the drugs listed as causing agranulocytosis. Furosemide, phenytoin, and the cephalosporins have been reported to cause this blood dyscrasia, and this patient had been prescribed all of these medications. This information was communicated to the physician on day 18 of the clinical course. Because the patient needed these medications, was clinically stable, and appeared to be improving, the physician decided not to discontinue any of these medications. During continuing therapy with the agents, the patient's white blood cell counts returned to normal, suggesting that this was not a drug-induced phenomenon.
Overwhelming infection can also cause both the aplastic anemic problem and agranulocytosis.
This patient was recovering from a serious diabetic foot infection, and perhaps this was the cause of the neutropenia. The patient remained clinically stable and without signs of progressive infection. Practitioners must continually monitor this type of patient for signs of infection and the trend in white blood cell counts, since an extremely low count could precipitate a life-threatening infection. Weekly blood counts were used to monitor the patient during this period of exposure to several risk factors for blood dyscrasias. As the patient recovered from her infections, her blood counts improved, suggesting a relationship between the two.