Naproxen and Agranulocytosis

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Abstract
To the Editor.— Agranulocytosis has been reported as a rare complication of nonsteroidal anti-inflammatory drug therapy. Specific nonsteroidals that have been reported to cause this include phenylbutazone,1indomethacin,2fenoprofen,3benoxaprofen,4ibuprofen,5and tolmetin.5A case of agranulocytosis during naproxen therapy that resolved when administration of the drug was discontinued is reported herein. Evidence from a search for the mechanism of the neutropenia is also presented. Report of a Case.— An 87-year-old man with long-standing seropositive rheumatoid arthritis was admitted for elective hernia repair. His arthritis had been managed in the four years prior to admission with naproxen, 250 mg twice a day. On admission he was noted to have a white blood cell count of 0.0023 ×103/mm3(0.0023 ×109/L), with 16% (0.16) polymorphonuclear leukocytes (0.000368 × 103/mm3[0.000368 × 109/L]) and 0% (0.00) band forms.