Korean Journal of Hematology  1999;34(3):507-511

A Case of Non-Immune Mediated Marrow Suppression Associated with Phenytoin Therapy.

Hyuck Joon CHUNG 1 ; Sung Gyun AHN ; Cheol Gweon JEONG ; Joon Seung PARK ; Do Yeun CHO ; Hyun Soo KIM ; Jin Hyuk CHOI ; Dong Ki NAM ; Ho Yeong LIM ; Hugh Chul KIM

Affiliations

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Keywords

Phenytoin; Leukopenia; Agranulocytosis

Country

Republic of Korea

Language

Korean

Abstract

Diphenylhydantoin (DPH) is one of the most widely used anticonvulsants for treatment and prevention of seizures. However it is frequently associated with drug-induced leukopenia. Hypersensitivity reactions to phenytoin are well recognized and can be severe. Phenytoin is associated with serious hematologic side effects such as agranulocytosis, thrombocytopenia, red cell aplasia and hemolytic anemia, either through humoral or cell-mediated immunemechanism. We describe a 57-year-old male patient who developed a severe granulocytopenia while taking phenytoin for 66 days in the total amount of 21.6 gram. Bone marrow examination showed isolated depletion of myeloid elements. After 10 days of phenytoin withdrawal and G-CSF treatment, the patient recovered from granulocytic suppression. Using in vitro culture, marrow suppression associated with phenytoin therapy was felt to be non-immune mediated marrow suppression.