Blood, 1946, Vol. 1, No. 1, pp. 53-66.
© 1946 American Society of Hematology, Inc.
THE VALUE OF PENICILLIN IN THE TREATMENT OF
AGRANULOCYTOSIS CAUSED BY THIOURACIL
MARY CATHERINE TYSON M.D.1,
PETER VOGEL M.D.1, and
NATHAN ROSENTHAL M.D.1
1 Hematology Laboratory, The Mount Sinai Hospital, New York.
Thiouracil has been found to be an effective drug in the treatment of hyperthyroidism. Agranulocytosis following its use occurred in nine cases, four of which
terminated fatally. In five others a complete and rapid recovery took place following penicillin therapy. The latter drug is believed to be ideal for all cases of agranulocytosis, and especially those in which chemotherapy has been used and may
have been responsible for the condition. Thus far we have not seen any report of
any untoward effect on the hemopoietic system from the use of penicillin.
The use of antibacterial agents for the treatment of agranulocytosis was suggested by Dameshek and Wolfson21 in 1942. It was believed by these authors that
patients with agranulocytosis died not of the leukopenia per se but of the sepsis
which developed secondarily to the lack of granulocytes. Two very severe cases
of aminopyrine agranulocytosis treated with sulfathiazole made complete recoveries. For the treatment of sulfonamide agranulocytosis, it was suggested that
a preparation differing from that which had already been used be given. With
the discovery of penicillin, and its complete lack of possible deleterious effect on
the bone marrow, its use was suggested by Dameshek17 (1944). A report on the
beneficial effects of this medication in a case of sulfonamide agranulocytosis was
later reported by Dameshek and Knowlton18 and similar cases by Sprague and
Ferguson19 and by Meredith and Fink.20
Since sulfonamides may cause further toxic effect on the bone marrow, we feel
that their use should be avoided in the treatment of agranulocytosis, especially
where a history of previous use is obtained. We do not agree with others21, 22
who continue the use of sulfonamides in the treatment of leukopenia or agranulocytosis where these very drugs may have been responsible for the condition. It
would seem better judgment to use penicillin, which by combating the bacterial
invasion of the body and the consequent toxemia enables the patient to survive
until the bone marrow cells regenerate.
