Agranulocytosis and Dipyrone: Case report with recurrence after reexposure

Authors

DOI:

https://doi.org/10.33448/rsd-v13i12.47797

Keywords:

Agranulocytosis; Neutropenia; Dipyrone.

Abstract

Introduction: Dipyrone is a drug derived from pyrazolone. Due to its analgesic and antipyretic effects, it has become widely used in Brazil and is among the ten most widely marketed drugs. Its association with agranulocytosis has been recognized since 1970, with a mortality rate of between 10 and 16%. Objective and Methodology: This case report presents a clinical case of agranulocytosis secondary to re-exposure to dipyrone with a suggestive clinical and laboratory picture. Conclusion: Anamnesis plays a crucial role in establishing the temporal relationship between the use of the drug and the appearance of signs and symptoms, with an impact on early diagnosis and appropriate therapeutic management for the patient's prognosis.

References

Alcoba Leza, M. (1966). Drug-induced agranulocytosis with medullary plasmacytosis and hyperglobulinemia. Revista Clínica Española, 103, 316–321.

Andersohn, F., Konzen, C., & Garbe, E. (2007). Systematic review: agranulocytosis induced by nonchemotherapy drugs. Annals of Internal Medicine, 146(9), 657–665.

Andrade, S., Bartels, D. B., Lange, R., Sandford, L., & Gurwitz, J. (2016). Safety of metamizole: a systematic review of the literature. Journal of Clinical Pharmacy and Therapeutics, 41(5), 459–477.

Bezerra, L. A., & Malta, D. J. N. (2016). Interferência medicamentosa em exames laboratoriais. Ciências Biológicas e da Saúde, 2(3), 41–48.

Blaser, L. S., Tramonti, A., Egger, P., Haschke, M., Krähenbühl, S., & Rätz Bravo, A. E. (2015). Hematological safety of metamizole: Retrospective analysis of WHO and Swiss spontaneous safety reports. European Journal of Clinical Pharmacology, 71(2), 209–217. https://doi.org/10.1007/s00228-014-1781-z

Carvalho, R., Henriques, C., Fernandes, M., Gouveia, C., & Gama, C. (2023). A case report on metamizole-induced agranulocytosis: Is the benefit worth the risk? Cureus, 15(1), e34467. https://doi.org/10.7759/cureus.34467

Christie, D. J. (1993). Specificity of drug-induced immune cytopenias. Transfusion Medicine Reviews, 7, 230.

Eleutério, O. H. P., Veronezi, R. N., Martinez-Sobalvarro, J. V., Marrafon, D. A. F. O., Eleutério, L. P., Rascado, R. R., Dos Reis, T. M., Podestá, M. H. M. C., & Torres, L. H. (2024). Safety of metamizole (dipyrone) for the treatment of mild to moderate pain—An overview of systematic reviews. Naunyn-Schmiedeberg's Archives of Pharmacology, 397(11), 8515–8525. https://doi.org/10.1007/s00210-024-03240-2

Ellrodt, A. G., Murata, G. H., Riedinger, M. S., et al. (1984). Severe neutropenia associated with sustained-release procainamide. Annals of Internal Medicine, 100, 197.

Federici, L., Weitten, T., Alt, M., Blaison, G., Zamfir, A., Audhuy, B., & Andres, E. (2008). Idiosyncratic drug-induced agranulocytosis. La Presse Médicale, 37(9), 1327–1333.

Gerson, S. L., & Meltzer, H. (1992). Mechanisms of clozapine-induced agranulocytosis. Drug Safety, 7(Suppl 1), 17.

Hamerschlak, N., & Cavalcanti, A. B. (2005). Agranulocitose e dipirona. Einstein, 3(2), 134.

Hamerschlak, N., Maluf, E., & Pasquini, R. (2005). Incidence of aplastic anemia and agranulocytosis in Latin America: the LATIN study. São Paulo Medical Journal, 123(3), 101–104.

Huber, M., Andersohn, F., Sarganas, G., Bronder, E., Klimpel, A., Thomae, M., Konzen, C., Kreutz, R., & Garbe, E. (2015). Metamizole-induced agranulocytosis revisited: Results from the prospective Berlin Case-Control Surveillance Study. European Journal of Clinical Pharmacology, 71(2), 219–227. https://doi.org/10.1007/s00228-014-1777-8

Interfarma. (2019). Guia 2019. https://www.interfarma.org.br/public/files/biblioteca/guia-interfarma-2019-interfarma2.

Johnston, A., & Uetrecht, J. (2015). Current understanding of the mechanisms of idiosyncratic drug-induced agranulocytosis. Expert Opinion on Drug Metabolism & Toxicology, 11, 243.

Kaufman, D. W., Kelly, J. P., Jurgelon, J. M., et al. (1996). Drugs in the aetiology of agranulocytosis and aplastic anaemia. European Journal of Haematology Supplement, 60, 23.

Maciá-Martínez, M. Á., Castillo-Cano, B., García-Poza, P., & Martín-Merino, E. (2024). Risk of agranulocytosis with metamizole in comparison with alternative medications based on health records in Spain. European Journal of Clinical Pharmacology, 80(10), 1503–1514.

https://doi.org/10.1007/s00228-024-03706-5

Naranjo, C. A., Busto, U., Sellers, E. M., Sandor, P., et al. (1981). A method for estimating the probability of adverse drug reactions. Clinical Pharmacology and Therapeutics, 46, 239–245.

Pisciotta, A. V. (1990). Drug-induced agranulocytosis: Peripheral destruction of polymorphonuclear leukocytes and their marrow precursors. Blood Reviews, 4, 226.

Santos, P. C. J. L. (2012). Hematologia: Métodos e Interpretação. Série Análises Clínicas e Toxicológicas. Roca.

Shinar, E., & Hershko, C. (1983). Causes of agranulocytosis in a hospital population: identification of dipyrone as an important causative agent. Israel Journal of Medical Sciences, 19(3), 225–229.

Tomidis Chatzimanouil, M. K., Goppelt, I., Zeissig, Y., Sachs, U. J., & Laass, M. W. (2023). Metamizole-induced agranulocytosis (MIA): A mini review. Molecular and Cellular Pediatrics, 10(1), 6. https://doi.org/10.1186/s40348-023-00160-8

Uetrecht, J., Zahid, N., Shear, N. H., & Biggar, W. D. (1988). Metabolism of dapsone to a hydroxylamine by human neutrophils and mononuclear cells. Journal of Pharmacology and Experimental Therapeutics, 245, 274.

Uetrecht, J., Zahid, N., Tehim, A., et al. (1997). Structural features associated with reactive metabolite formation in clozapine analogues. Chemical Biology Interactions, 104, 117.

Published

10/12/2024

How to Cite

FERNANDES, V. P.; SCHULTZ, T.; ROCHA, S. de F. . Agranulocytosis and Dipyrone: Case report with recurrence after reexposure. Research, Society and Development, [S. l.], v. 13, n. 12, p. e135131247797, 2024. DOI: 10.33448/rsd-v13i12.47797. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/47797. Acesso em: 5 jan. 2025.

Issue

Section

Health Sciences