著者

小島 寛 長谷川 雄一 渋谷 和子 中澤 正樹 依田 安弘 阿部 帥

出版者

一般社団法人 日本血液学会

雑誌

臨床血液 (ISSN:04851439)

巻号頁・発行日

vol.31, no.2, pp.189-193, 1990

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A 55-year-old man was admitted to our hospital for the evaluation of neutropenia. On physical examination, he had apthae and splenomegaly. CBC showed 1,000/&mu;<i>l</i> WBC with 5% neutrophils, and microcytic anemia consistent with iron deficiency. Bone marrow examination revealed a marked decrease of mature neutrophils, but normal percentage of immature myeloid cells. There was no morphological abnormality in the hemopoietic cells. He had no drug or family history responsible for the neutropenia. Anti-neutrophil auto-antibody was negative. Hence, a diagnosis of chronic idiopathic neutropenia (CIN) was made. He developed frequent episodes of infection such as penitis, peri-anal infection, gingivitis, and pharingitis. He was treated with steroid pulse therapy, anabolic hormone, and high dose &gamma;-globulin infusion, but no significant improvement occured. Then, recombinant granulocyte-colony stimulating factor (rG-CSF) was started. The neutrophil count was normalized by the 7th day of 5 &mu;g/kg/day rG-CSF administration. The administration of G-CSF was discontinued after a 14-day course. Thereafter, the neutrophil count remained at near normal level (approximately 1,500/&mu;<i>l</i>) and there have been no episodes of infection in the last 5 months. However this cannot be explained simply by the direct effect of rG-CSF on the myeloid precursors; rather, it suggests some unknown effect of G-CSF on the bone marrow microenvironment regulating myeloid hemopoiesis. We consider this to be a rare case of CIN with frequent episodes of infection, which was successfully treated with G-CSF.