Spironolactone-induced agranulocytosis

Spironolactone-induced agranulocytosis: a case report

A 43-year-old woman with liver cirrhosis and hepatocellular carcinoma was admitted for the chief problem of ascites. Laboratory data revealed a leukocyte count of 3.8 x 10(9)/L on the second day of admission. Spironolactone was prescribed for diuresis beginning on the third day. Routine blood tests on the tenth day disclosed marked leukopenia (1.8 x 10(9)/L). Four days later, the leukocyte count was still 1.8 x 10(9)/L and a differential count revealed agranulocytosis (neutrophils, 0.25 x 10(9)/L). Eight days after withdrawal of spironolactone, the leukocyte count returned to normal (leukocytes, 4.9 x 109/L; neutrophils, 1.76 x 10(9)/L). On review of the patient's clinical condition, concurrent medication, and previous reports, we highly suspected that this episode of agranulocytosis was caused by spironolactone. Unlike four previously reported cases, this one did not involve furosemide, which is reported to be associated with leukopenia and agranulocytosis.

Hormonal therapies in acne

Hormones, in particular androgen hormones, are the main cause of acne in men, women, children and adults, in both normal states and endocrine disorders. Therefore, the use of hormonal therapies in acne is rational in concept and gratifying in practice. Although non-hormonal therapies enjoy wide usage and continue to be developed, there is a solid place for hormonal approaches in women with acne, especially adult women with persistent acne. This review covers the physiological basis for hormonal influence in acne, the treatments that are in use today and those that show promise for the future. The main treatments to be discussed are oral contraceptives androgen receptor blockers like spironolactone and flutamide, inhibitors of the enzyme 5 alpha-reductase and topical hormonal treatments.

Spironolactone

The greater survival rate of premature neonates has increased the use of various drugs, including diuretics, which may be used for a variety of clinical indications in neonates. Rational use of specific diuretics, including recognition of the potential complications, depends on adequate knowledge and clinical assessment by NICU nurses.