Hyperleucocytosis following G-CSF treatment for sulfasalazine-induced agranulocytosis

Abstract

Agranulocytosis is a rare but serious adverse effect of sulfasalazine treatment. We present a case of a 51-yearold woman receiving sulfasalazine for inflammatory arthritis presenting with sore throat, fever, lethargy and leucopenia (white cell count 0.9×10 9 /L). After 9 days of treatment with filgrastim (granulocyte-colony stimulating factor, G-CSF), her white cell count increased to 77.4×10 9 /L. This case highlights the importance of recognising sulfasalazine-induced agranulocytosis and the management of hyperleucocytosis following G-CSF treatment, to prevent harmful sequelae.