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March 1985

Granulocytes, Lymphocytes, and Toxic Epidermal Necrolysis

Author Affiliations

Department of Dermatology; Department of Hematology Hopital Henri Mondor Université Paris Val de Marne 94010 Creteil, France

Arch Dermatol. 1985;121(3):305. doi:10.1001/archderm.1985.01660030025002

To the Editor.—  As the medical staff of an intensive care unit for severe skin diseases, we were disturbed by the article by Westly and Wechsler1 about granulocytic leukopenia in ten patients with toxic epidermal necrolysis (TEN).1 Our own findings about hematologic alterations in 26 TEN patients have been recently published.2 There is a lot of discordance between the two studies.Eleven of our 26 patients had a decreased white blood cell (WBC) count (<4,000/cu mm), but in eight cases this leukopenia resulted from a lymphopenia and not from a granulocytopenia. Only three of 26 patients had a granulocytopenia, with granulocyte counts below 1,500/cu mm, three to nine days after the beginning of a drug-induced TEN. Two of these three patients had a bone marrow aspiration showing alterations of the myeloid lineage suggestive of drug toxicity. Similar alterations in the myeloid lineage were seen in two of

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