Diagnosis and management of idiopathic drug-induced and severe neutropenia and agranulocytosis: What should the lung specialist know?

Abstract

In this paper, we report and discuss the diagnosis and management of severe neutropenia and agranulocytosis (neutrophil count of <0.5 x 109/L) related to non-chemotherapy drug intake, called “idiosyncratic”. Lung specialists may be faced with these events. In fact, all classes of drugs have been implicated (“causative”) and clinical manifestations may include pneumonia or related disorders. Recently, several prognostic factors have been identified that may be helpful when identifying frailty patients. Old age (>65 years), septicemia or shock, metabolic disorders such as renal failure, and a neutrophil count below 0.1×109/L have been consensually accepted as poor prognostic factors for hematological recovery. In this potentially life-threatening disorder, modern management with broad-spectrum antibiotics and hematopoietic growth factors (particularly G-CSF), is likely to improve the prognosis. Thus, with appropriate management, the mortality rate of idiosyncratic drug-induced severe neutropenia and agranulocytosis is currently around 5%.