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Drug-Induced Agranulocytosis in Elderly Patients: Diagnosis and Management of Life-Threatening Infections and Septic Shock

Emmanuel Andrès, Rachel Mourot, Olivier Keller, Khalid Serraj and Thomas Vogel

In this paper, we discuss the diagnosis and management of life-threatening infections including septic shock, in elderly patients presenting with acute drug-induced neutropenia (neutrophil count of <0.5 x 109/L). Also known as “idiopathic agranulocytosis,” it remains a potentially serious adverse effect of various drugs, especially in vulnerable elderly patients. Clinical manifestations include severe deep tissue infections (e.g. pneumonia), septicemia and septic shock in approximately two-thirds of cases. Recently, several factors have been identified in order to help recognize patients with a poor prognosis. These include: Old age (>65 years), septicemia or septic shock, metabolic disorders such as renal failure and a neutrophil count below 0.1 × 109/L. In this potentially life-threatening disorder, modern management with broad-spectrum antibiotics and hematopoietic growth factors (particularly G-CSF), is likely to improve the prognosis, even in elderly patients.