28079821 Visualization

A 67 Age - year Age - old Age woman Sex was sent Clinical_event to emergency Nonbiological_location department Nonbiological_location because of fever Sign_symptom and sore Sign_symptom throat Biological_structure .
Her medical history included ESRD Disease_disorder with regular hemodialysis Therapeutic_procedure 3 Frequency times Frequency per Frequency week Frequency for 15 Duration years Duration , hyperuricemia Disease_disorder and gout Disease_disorder .
She also had comorbidity such as dyslipidemia Disease_disorder , hypertension History , secondary Detailed_description hyperparathyroidism Disease_disorder , and diabetes Disease_disorder .
The hemogram Diagnostic_procedure revealed a white Diagnostic_procedure blood Diagnostic_procedure cell Diagnostic_procedure count Diagnostic_procedure ( WBC Diagnostic_procedure ) of 700/μL Lab_value , with 2% Lab_value neutrophils Diagnostic_procedure , 94% Lab_value lymphocytes Diagnostic_procedure and 2% Lab_value monocytes Diagnostic_procedure , hemoglobin Diagnostic_procedure 11.1 Lab_value   g/dL Lab_value , and platelet Diagnostic_procedure count Diagnostic_procedure , 131,000/μL.
Under the impression of febrile Detailed_description neutropenia Sign_symptom and acute Detailed_description pharyngitis Disease_disorder , she was admitted Clinical_event to our hematologic Nonbiological_location ward Nonbiological_location for further survey and management.
Broad Detailed_description - spectrum Detailed_description antibiotics Medication with piperacillin Medication 2 Dosage   g Dosage and tazobactam Medication 0.25 Dosage   gm Dosage i.v. Administration
q8h Dosage had been administered and her infection Sign_symptom sign Sign_symptom resolved gradually.
Upon admission, we reviewed her oral medication: glipizide Medication 5 Dosage   mg Dosage tid Dosage , saxagliptin Medication 2.5 Dosage   mg Dosage qd Dosage , fenofibrate Medication 600 Dosage   mg Dosage qd Dosage , aluminum Medication hydroxide Medication 324 Dosage   mg Dosage tid Dosage , folic Medication acid Medication 5 Dosage   mg Dosage qd Dosage , calcium Medication carbonate Medication 1000 Dosage   mg Dosage tid Dosage , and febuxostat Medication 40 Dosage   mg Dosage qd Dosage .
Besides, she also received epoetin Medication - beta Medication 2000 Dosage iu Dosage i.v.tiw.
Except for febuxostat Medication , all the other drugs had been used for more Duration than Duration 1 Duration year Duration .
Febuxostat Medication was administered 2½ Date months Date before Date admission for inadequate serum uric acid control by allopurinol Medication 50 Dosage   mg Dosage qd Dosage .
Two Date weeks Date before Date febuxostat exposure, routine laboratory Diagnostic_procedure test Diagnostic_procedure revealed WBC Diagnostic_procedure 6000/μL Lab_value and serum Detailed_description uric Diagnostic_procedure acid Diagnostic_procedure level 9.8 Lab_value  mg/dL.
Febuxostat Medication was discontinued thereafter due to the causal relationship of agranulocytosis Disease_disorder cannot be excluded.
Besides, we also surveyed viral infection and autoimmune disorder.
There were no clinical or laboratory evidence of Epstein Detailed_description – Barr Detailed_description virus Detailed_description , cytomegalovirus Detailed_description , or human Detailed_description immunodeficiency Detailed_description virus Detailed_description infections Disease_disorder ; antinuclear Diagnostic_procedure antibody Diagnostic_procedure ( ANA Diagnostic_procedure ) and antiextractable Diagnostic_procedure nuclear Diagnostic_procedure antigen Diagnostic_procedure ( anti Diagnostic_procedure - ENA Diagnostic_procedure ) were both negative Lab_value .
Bone Diagnostic_procedure marrow Diagnostic_procedure examination Diagnostic_procedure during hospitalization showed hypocellular Sign_symptom marrow Biological_structure with a marked decrease Lab_value in myeloid Diagnostic_procedure component Diagnostic_procedure but no evidence of hematologic Biological_structure neoplasms Sign_symptom .
Chromosome Diagnostic_procedure analysis Diagnostic_procedure of bone Biological_structure marrow Biological_structure was normal Lab_value karyotype Lab_value .
The patient denied History history History of History radiation History or History chemicals History exposure History .
After stopping febuxostat Medication for 17 Duration days Duration , her neutropenia Sign_symptom improved significantly ( WBC Diagnostic_procedure 2100/μL Lab_value , and neutrophil Diagnostic_procedure 66% Lab_value ), without any granulocyte Medication colony Medication - stimulating Medication factor Medication (G-CSF) support.
After discharge Clinical_event , her WBC Diagnostic_procedure and differential Diagnostic_procedure count Diagnostic_procedure was completely normal Lab_value during follow Clinical_event - up Clinical_event (Fig.1).
This study was approved by our institutional review board.