Tuberc Respir Dis.  2015 Apr;78(2):125-127. 10.4046/trd.2015.78.2.125.

Agranulocytosis Induced by Ethambutol in a Patient with Pulmonary Tuberculosis

• Moon KM
• Han MS
• Chung SH
• Kim JR
• Kim JY
• Jung SY
• Cho Y

• KMID: 2320605
• DOI: http://doi.org/10.4046/trd.2015.78.2.125

Abstract

We report a case of agranulocytosis caused by ethambutol in a 79-year-old man with pulmonary tuberculosis. He was referred for fever and skin rash developed on 21th day after antituberculosis drugs (isoniazid, rifampicin, ethambutol, and pyrazinamide) intake. Complete blood count at the time of diagnosis of pulmonary tuberculosis was normal. On the seventh admission day, agranulocytosis was developed with absolute neutrophil count of 70/microL. We discontinued all antituberculosis drugs, and then treated with granulocyte colony-stimulating factor. Three days later, the number of white blood cell returned to normal. We administered isoniazid, pyrazinamide, and ethambutol in order with an interval. However, fever and skin rash developed again when adding ethambutol, so we discontinued ethambutol. After these symptoms disappeared, we added rifampicin and ethambutol in order with an interval. However after administering ethambutol, neutropenia developed, so we discontinued ethambutol again. He was cured with isoniazid, rifampicin, and pyrazinamide for 9 months.

Keyword

Agranulocytosis; Ethambutol; Tuberculosis, Pulmonary

MeSH Terms

Aged
Agranulocytosis*
Blood Cell Count
Diagnosis
Ethambutol*
Exanthema
Fever
Granulocyte Colony-Stimulating Factor
Humans
Isoniazid
Leukocytes
Neutropenia
Neutrophils
Pyrazinamide
Rifampin
Tuberculosis, Pulmonary*
Ethambutol
Granulocyte Colony-Stimulating Factor
Isoniazid
Pyrazinamide
Rifampin

Figure

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  Figure 1 Patient's absolute neutrophil count (ANC) progression from the onset of antituberculosis therapy. G-CSF, granulocyte colony-stimulating factor.

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