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Thrombocytopenia and pancytopenia: case report A 62-year-old woman developed thrombocytopenia and pancytopenia during treatment with temozolomide. Additionally, metronidazole had contributed to the development of thrombocytopenia [not all routes and dosages stated]. In April 2016, the woman, who had glioblastoma, was admitted for further treatment. Six weeks before, she had undergone maximum resection of glioblastoma. Due to the presence of residual tumour in the frontal lobe, she was scheduled for concomitant chemoradiotherapy. She received three-dimensional conformal radiotherapy (RT) 60Gy in 30 fractions for 6 weeks with concomitant temozolomide of 140mg (75 mg/m2) at a daily dose. At that time, her baseline blood counts were almost normal with normal serum chemistry. After concomitant chemoradiotherapy, she developed grade 1 diarrhoea, fatigue and Clostridium difficile gut colonisation. At that time, combined treatment was discontinued. Two weeks after the completion of oral metronidazole treatment, she was admitted for further chemoradiotherapy. At the time of admission, her blood counts showed severe pancytopenia (Hb 118 g/L, WBC 0.9 × 109/L, absolute neutrophil count (ANC) 0.3 × 109/L and platelets 4 × 109/L). A few hours later, she developed petechial bleeding in the skin and became subfebrile [time to reactions onset not stated]. The pancytopenia was transient. The woman received ceftazidime, filgrastim and platelet transfusions and her anticonvulsants were discontinued. Despite filgrastim treatment her thrombocytopenia (grade 4) persisted. She received a total of nine platelet transfusions and one transfusion of PRBC. However, despite this, her platelets remained low. Thereafter, a complete haematological work-up was performed. Bone marrow aspiration showed a normocellular bone marrow with the presence of blast cells (8%) with occasional promyelocytes (5%). Due to the presence of blasts and promyelocytes and immature eosinophils, immunophenotyping of the bone marrow was performed, which showed no signs of leukaemia, although it showed features related to myeloid recovery. Other diagnostic tests for the evaluation of long-term thrombocytopenia showed unremarkable results. Her thrombocytopenia persisted for the next 6 months. Her blood counts still showed decreased platelet levels with slight to moderate neutropenia. Later, in January 2017, she underwent a second surgical tumour resection. Unfortunately, in June 2017, she died due to progressive disease. Her family refused a post-mortem. For pancytopenia and thrombocytopenia, her temozolomide chemotherapy, and for thrombocytopenia, metronidazole was considered as culprit [not all outcomes stated]. Stepanovic A, et al. Long-lasting thrombocytopenia after transient pancytopenia induced by short-term concomitant radiotherapy and temozolomide. European Journal of Case 803517250 Reports in Internal Medicine 7: No. 10, 7 Jul 2020. Available from: URL: http://doi.org/10.12890/2020_001785

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