Agranulocytosis,Plasmacytosis,and Thrombocytosis Followed by a Leukemoid Reaction Due to Acute Acetaminophen Toxicity

Abstract

OBJECTIVE:

To describe a patient who developed hepatotoxicity, reactive plasmacytosis with thrombocytosis and life-threatening agranulocytosis, followed by a leukemoid reaction, apparently caused by acute acetaminophen toxicity.

SETTING:

University-affiliated hospital.

CASE SUMMARY:

A 19-year-old white woman who took an overdose of acetaminophen developed hepatotoxicity and reactive plasmacytosis with thrombocytosis and life-threatening agranulocytosis, followed by a leukemoid reaction. Symptoms, signs, and laboratory findings regressed with symptomatic therapy during the follow-up period.

CONCLUSIONS:

We believe that acute acetaminophen toxicity was responsible for these hematologic abnormalities. This profile of hematologic adverse effects associated with acetaminophen toxicity has not been reported previously.