Methylprednisolone induced morning lymphocytosis: A prospective study in patients with immune mediated inflammatory disorders

Contrasting with the lymphopenia classically reported after administration of glucocorticoids, a lymphocytosis has been sometimes observed in patients after glucocorticoid administration. We here determine prospectively the timing and magnitude of methylprednisolone (mPDN)-induced lymphocytosis and study the effects of concomitant propranolol administration on lymphocyte count (Ly). Ly was measured before and 24 to 72hours after initiating mPDN treatment in 20 patients with immune-mediated inflammatory disorders (IMID). After one week, patients with increased Ly were divided in two groups receiving, in addition to mPDN, either propranolol or a placebo; Ly was determined 4 days later. Lymphocyte subpopulations and mPDN plasma levels were determined in subsets of the patients. Values are expressed as median with 25%–75% interquartile range. A 73.4% (37–305) increase of Ly was observed in 18/20 patients as soon as 48 (48–72) hours after initiating mPDN (32mg; 16–32). Lymphocytosis (Ly≥4000/μL) was observed in 7 patients and hyperlymphocytosis (Ly≥5000/μL) in 4 of them. The increase in Ly was noted both for B and T cells. Median mPDN plasma levels (n=13) were 97.4ng/mL (IQR 67–489) and 3.2 (IQR 2.1–5.1) respectively 8hours and 24hours after oral mPDN administration. No significant change in Ly was shown under propranolol (p=0.570). A morning lymphocytosis observed during mPDN treatment occurs in the very first days of mPDN administration. Our results do not support the hypothesis of an increased adrenergic tone responsible for this phenomenon. Identifying this unexpected etiology of lymphocytosis could mitigate the need for unnecessary supplementary investigations in clinical practice. Contrastant avec la lymphopénie classiquement rapportée après l’administration de glucocorticoïdes, une lymphocytose a parfois été observée chez des patients après l’administration de glucocorticoïdes. Nous déterminons ici de manière prospective le moment et l’ampleur de la lymphocytose induite par la méthylprednisolone (mPDN) et étudions les effets de l’administration concomitante de propranolol sur la numération des lymphocytes (Ly). Ly a été mesuré avant et 24 à 72heures après le début du traitement par mPDN chez 20 patients souffrant de maladies inflammatoires immunomédiées (IMID). Après une semaine, les patients présentant une augmentation de Ly ont été divisés en deux groupes recevant, en plus de la mPDN, soit du propranolol, soit un placebo; Ly a été déterminé 4jours plus