SPIRONOLACTONE-INDUCED AGRANULOCYTOSIS

OBJECTIVE: To report a case of agranulocytosis secondary to spironolac tone in a patient with cryptogenic liver disease. CASE SUMMARY: A 58-y ear-old Hispanic woman with cryptogenic cirrhosis was admitted to Univ ersity Hospital on October 31, 1995, Laboratory data revealed a leukoc yte count of 1.0 x 10(3)/mm(3) and an absolute neutrophil count (ANC) of 10 cells/mm(3). Prior to treatment with spironolactone, the leukocy te count was 10.2 x 10(3)/mm(3) and ANC 8400 cells/mm(3). Agranulocyto sis resolved 5 days following the discontinuation of spironolactone. R esults from the bone marrow biopsies before and after treatment with s pironolactone suggested that agranulocytosis was caused by the drug's toxic effect on the bone marrow. DISCUSSION: Drug-induced agranulocyto sis is a serious adverse effect, occurring at a rate of approximately 6.2 cases per million persons each year, In addition to the case repor ted here. three other reports of agranulocytosis secondary to spironol actone have been published in the literature. Several factors have bee n identified that may increase a patient's risk for developing agranul ocytosis, including increased age, hepatic or renal impairment, drug d osage and duration, and concurrent medications. CONCLUSIONS: Agranuloc ytosis secondary to spironolactone is a serious potential adverse effe ct. Patients with risk factors for developing this adverse effect shou ld be closely monitored since early detection and discontinuation of s pironolactone can improve prognosis.