[Successful treatment of chronic idiopathic neutropenia in an elderly with ciclosporin].

An 83-year-old man with chronic obstructive pulmonary disease, hypothyroidism, and osteoporosis developed neutropenia. He was diagnosed with agranulocytosis based on suppression and maturation arrest of myeloid series in the bone marrow. All of his prescriptions were stopped, and he was given granulocyte colony-stimulating factor because he was suspected to have drug-induced agranulocytosis. His neutropenia improved for a while, but it returned a month later. Serum soluble interleukin-2 receptor levels were elevated in his blood, and an abdominal computed tomography scan revealed splenomegaly with no lymph node enlargement. However, due to his old age, a splenectomy was not performed, and no definitive diagnosis was given. He received rituximab therapy after being considered for splenic marginal zone lymphoma or autoimmune neutropenia. His splenomegaly improved, but his neutropenia did not. He was then given ciclosporin, which resulted in a complete response. Because of the presence of large granular lymphocytes in the peripheral blood and bone marrow but no T-cell receptor gene rearrangement, the case was defined as chronic idiopathic neutropenia with activated T cells.