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March 23, 1994


Author Affiliations

From the Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.

JAMA. 1994;271(12):935-938. doi:10.1001/jama.1994.03510360061038


Patient 1  A 60-year-old man with moderately severe congestive heart failure secondary to cardiomyopathy was treated with an experimental inotropic drug, vesnarinone (Otsuka America, Rockville, Md), known to be associated with agranulocytosis. Blood cell counts were monitored weekly. Ten weeks after beginning treatment, the total white blood cell count, previously normal, was 2.6×109/L with an absolute neutrophil count of 1.282×109/L The patient was not symptomatic. The experimental drug was discontinued. Two days later the absolute neutrophil count was 0.396×109/L. The patient was hospitalized for observation. A bone marrow aspirate showed absence of mature granulocytes and myeloid precursor cells. The patient was treated with oral cephalexin. Fever occurred to a temperature of 38.6°C (101.4°F), leading to withdrawal of an intravenous catheter. Over a week both total white blood cell and neutrophil numbers returned to normal.

Patient 2  A 75-year-old woman with severe congestive