Captopril-induced toxic epidermal necrolysis and agranulocytosis successfully treated with granulocyte colony-stimulating factor

Captopril-induced bone marrow suppression is rare, except in certain high-r isk patient populations. Severe exfoliative rashes have also been associate d with captopril, but a combined presentation of toxic epidermal necrolysis and agranulocytosis has not been previously described. We report an unusua l case of captopril-induced toxic epidermal necrolysis with agranulocytosis in a patient with no known risk factors. The bone marrow suppression was s uccessfully treated using granulocyte colony-stimulating factor (G-CSF), an d the white blood cell (WBC) count recovered within 3 days after starting t herapy. This case underscores the early experience with captopril, which sh owed a strong correlation between high doses used to treat hypertension and bone marrow suppression.