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Pharyngitis is a common presenting symptom of agranulocytosis.

This table is from a levamisole study, but same occurs with methimazole, etc.

From what I understand, infections are not diagnosed in most of these cases.

And I've never understood something...

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What's the mechanism of pharyngitis then... infection that is not captured? Some reaction of the tonsils as immune organs? Any analogy to periodic fever syndromes?

Having trouble finding answer online.. anyone know?

@medrants @tony_breu @rabihmgeha

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Also, seems like throat pain is not as common in chemo-induced neutropenia. Even though a lot of these patients have an additional reason to have it (mucositis). What's up with that?
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More from @sargsyanz see all

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Zaven Sargsyan
@sargsyanz
Couple years ago I went for a run and finished with some pushups. By the last set I was exhausted, and eased down onto my chest.

When I lifted my head, I had to do a double take.

[this story may be boring for Spanish-speakers and herpetologists]

1/9
A lizard was parked on a bench two feet in front of my face, looking straight at me.

I stared back amused.

And then the lizard did several pushups.

Then paused.

Then did some more.

2/
I was slack-jawed.

Did this lizard just imitate me?
Are lizards playful?
Am I dazed from the heat, hallucinating?

I did a few more pushups, keeping eye contact.

It did a few more back.

When I was sure I wasn't dreaming I reached for my phone, but it scampered away.

3/
Read 9 tweets
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Zaven Sargsyan
@sargsyanz
In hypernatremia, it’s common to estimate the free water deficit. A shortcut in an average-sized person is (Serum Na - 140) / 3 = liters of deficit.

Na is 146? (146-140)/3 = 2L FWD.

BUT, consider...

1/3
That when you are hypovolemic, your serum Na can either be high (if you don't drink to replace the H2O you lose) or low (if you replace H2O > Na).

And anywhere in between!

So if the balance falls >140, and your doc’s estimating a deficit, that’s only FREE water deficit.

2/
The patient may have an additional isotonic fluid deficit.

That person with Na of 146 may actually be 8 liters down.

6 liters of isotonic salt water

+ 2 liters of just water.

3/
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Zaven Sargsyan
@sargsyanz
Eosinophils matter:

Inspired by yesterday’s @CPSolvers case + last week’s NEJM case, reprising this thread with 5 more real case examples of this take-home point:

In acute presentations, eosinophilia is often a pivot point: it dramatically shifts/narrows the ddx.

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Background: Glucocorticoids kill eosinophils. In acutely ill/stressed patients, the high endogenous cortisol should melt away your normal eos.

If you're acutely ill and have eosinophilia, the eos are probably related to why you're sick.



2/
Background: it's absolute counts that matter. Eosinophilia is defined as AEC > 450.

Total WBC 2K with 15% eos? AEC is 300 (normal)
Total WBC 20K with 3% eos? AEC is 600 (elevated)

3/
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