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Leukocytosis with atypical lymphocytes of varying degrees of intensity are uniquely characteristic of the early phase of the disease, although leukopenia may occasionally precede the leukocytosis.19,22 Leukocytosis with early neutrophilia and late monocytosis is, after eosinophilia, the most common hematological alteration, followed by atypical lymphocytosis in 27%67% of the patients.15,44 Other less frequent findings include lymphopenia, leukopenia, thrombocytopenia, thrombocytosis, and pancytopenia, which are associated with a more severe prognosis.15,33,46 Leukocytosis is largely due to the increase in lymphocytes caused by the massive activation of CD4+ and CD8+ lymphocytes, initially by the medication and after its withdrawal, by the reactivation of latent viral infections.19,23 Atypical lymphocytosis is a nonspecific response to a probable antigenic stimulus (virus, drug, graft-versus-host reaction), where there is rapid production and early release of immature lymphocytes, which are subsequently removed from circulation before mitosis.47 Therefore, a high percentage of atypical lymphocytes may be a reflection of more intense stimulation by the antigen (drug and/or infection).23,47 Leukocytosis can also be induced by corticosteroid therapy during treatment

The most frequent and preferable material used is leather