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 109/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 109/L). Four days later, the leukocyte count was still 1.8 x 109/L and a differential count revealed agranulocytosis (neutrophils, 0.25 x 109/L). Eight days after withdrawal of spironolactone, the leukocyte count returned to normal (leukocytes, 4.9 x 109/L; neutrophils, 1.76 x 109/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.
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