J.Jpn. Surg. Soc.
ISSN 1880-1129

[Abstract] [Full Text PDF] （in Japanese / 3322KB） [Members Only And Two Factor Auth.]

J.Jpn. Surg. Soc.. 80(3): 226-231, 1979

Original article

BENIGN ESOPHAGEAL STRICTURE POSSIBLY DUE TO DRUG-INDUCED AGRANULOCYTOSIS: REPORT OF A CASE

First Department of Surgery, Tokyo Medical and Dental University, School of Medicine, Tokyo
*) First Department of Medicine, Tokyo Medical and Dental University, School of Medicine, Tokyo
**) Department of Pathology, Central Laboratory, Tokyo Medical and Dental University, School of Medicine, Tokyo

Kunihide Yoshino, Ryoji Hatano, Akihiko Nishimura, Tohru Takiguchi, Matsutoshi Menjo, Tadashige Murakami, Hiroyuki Hamaguchi*), Nozomu Aoki**)

A 45-year old female presented with acute progression of near total esophageal stricture. She had been diagnosed as schizophrenics, for which she was placed on Carbamazepine 400 mg/day for 25 days. On The 13th day of drug administration, spiking fever of 38°C, irregular red-purple skin rash on the bilateral forearm, sore throat with thick white coat, and jaundice appeared. Severe leukopenia of 800/mm3 was noticed. Bone marrow study showed marked agranulocytosis. About one month after drug ingestion, she began to notice progressive dysphasia. Barium swallow showed a funnel-shaped dilatation of the upper esophagus and a near-total obstruction of the midesophgus. Endoscopy showed severe inflammatory reaction with erosion and ulcer of the mucosa at the midesophagus. Biopsy showed granulomatous inflammation. The thoracic esophagus was removed by blunt dissection and stripping and esophagojejunostomy of retrosternal route was performed by sternal splitting with removal of manubulium. Surgical specimen showed shallow ulceration of the mucosa with thickening of the wall. Histology showed non-specific granulomatous inflammation of the esophagus. Drug-induced esophageal stricutre is rare occurrence, most of which was associated with a certain condition inhibiting esophageal passage such as external compression of esophagus due to enlarged left atrium in the cardiac patients. Responsive agents reported were KCI tablet, doxycycline, and tetracycline and possible mechanism was contact ulceration with benign prognsosis. To our knowledge, esophageal stricture due to Carbamazepine has not been reported. Esophageal stricture due to agranulocytosis has been sporadically reported, most of which were due to agranulocytosis by sulfathiazole and sulfadiazine. Carbamazepine is known to cause agranulocytosis and the the present case was considered to be most likely due to agranulocytosis induced by Carbamazepine.

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