Agranulocytosis and Anemia during Treatment of Seizure with Phenytoin
Keywords:
Phenytoin, Agranulocytosis, AnemiaAbstract
Phenytoin has been widely used in clinical practice with a good efficacy but its adverse drug reaction is also incessantly reported. A 72-year-old man with lobar hemorrhage at the left parieto-occipital lobe and old ischemic stroke who developed seizure 3 times and phenytoin was used to control meanwhile, his seizure was investigated. After 22 days of phenytoin administration, his complete blood count revealed bicytopenia including white blood cell count of 1.3 x 109/L with an absolute neutrophil count of 0.338 x 109/L and hemoglobin level of 10.1 g/dL. The bone marrow aspiration and trephine biopsy confirmed markedly decreased of erythroid and myeloid precursors. He was diagnosed with agranulocytosis most likely from phenytoin. Phenytoin was discontinued and substituted by levetiracetam. Filgrastim was also prescribed for neutropenia. Nine days later, he recovered from agranulocytosis without any serious infection.
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