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Case Reports
June 1928


Author Affiliations

From the Departments of Pediatrics and Pathology, University of Kansas School of Medicine and the Children's Mercy Hospital.

Am J Dis Child. 1928;35(6):1041-1047. doi:10.1001/archpedi.1928.01920240088012

Several case reports during the last few years have directed attention to a peculiar blood dyscrasia characterized by a great diminution in the number of polymorphonuclear neutrophils and associated with a gangrenous ulceration of the tonsils. In 1922, Schultz1 reported six cases and called the condition "agranulocytic angina."

The syndrome affects chiefly women of middle age and usually terminates fatally. The onset is sudden, with fever and sore throat; in several instances, it followed closely the extraction of teeth. The characteristic lesions are rapidly spreading ulcers invariably present on the tonsils and pharynx, often on the gums, buccal walls and tongue and about the genitals. There is usually little if any enlargement of the regional lymph nodes, and in about one half of the cases icterus is present. The blood shows a relative lymphocytosis with a disappearance of all or almost all of the leukocytes of the granular or