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Unexpected outcome (positive or negative) including adverse drug reactions
Case report
A fatal case of levamisole induced bone marrow failure
  1. John Titus George1,
  2. Asisha M Janeela1,
  3. Elanthenral Sigamani2 and
  4. Alice Joan Mathuram1
  1. 1 Department of General Medicine, Christian Medical College and Hospital Vellore, Vellore, India
  2. 2 Department of Pathology, Christian Medical College and Hospital Vellore, Vellore, India
  1. Correspondence to Dr John Titus George, johntgeorg{at}gmail.com

Abstract

A 20-year-old college student presented with high grade, intermittent fever for 10 days associated with blood stained loose stools after taking tablet levamisole for 17 days for vitiligo vulgaris. He was febrile, had a toxic appearance and appeared pale. Investigations showed neutropaenia with thrombocytopaenia. Blood cultures were sterile and stool cultures did not grow any enteric pathogens. His bone marrow examination was suggestive of an aplastic anaemia. He was administered empirical antibiotics, granulocyte colony stimulating factor and platelet transfusions. However, his fever and blood stained stools persisted. A repeat bone marrow examination after 2 weeks still revealed a hypoplastic marrow. Hence, a diagnosis of a levamisole induced bone marrow failure was made. While being worked up for an allogeneic stem cell transplantation, he developed neutropaenic enterocolitis and refractory septic shock with carbapenem resistant Klebsiella pneumoniae and succumbed to his illness.

  • general practice/family medicine
  • haematology (incl blood transfusion)
  • toxicology
  • pharmacology and therapeutics

http://dx.doi.org/10.1136/bcr-2019-231167

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    Footnotes

    • Contributors JTG and AMJ were involved in the primary evaluation and management of the patient, conception and drafting of the case report. AJM and AMJ were involved in reviewing existing literature and revising the report. ES was involved in providing the final histopathological diagnosis and revising the report. JTG is a guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Parental/guardian consent obtained.