Rosiglitazone
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Pancytopenia, myelosuppression and exophthalmos: case report A 60-year-old woman presented with marrow suppressive pancytopenia manifesting as myelodysplastic syndrome (MDS), hypoerythropoietinaemia and exophthalmos [proptosis] during treatment with rosiglitazone for type 2 diabetes mellitus. The woman, a retired nurse, had been receiving rosiglitazone [Avandia] 4 mg twice daily since 2004. In 2005, a screening complete blood count revealed mild leucopenia and new-onset anaemia. A bone marrow biopsy was performed, which showed mild dyserythropoiesis, dysmegakaryopoiesis, a myeloid left shift and morphological findings suggestive of early MDS. She started receiving darbepoetin. Upon presentation in 2007, the woman was distressed with the prognosis of MDS, and was experiencing proptosis, ocular pain and progressive eye irritation. Laboratory tests were remarkable for leucopenia and anaemia. She had an HbA1c of 6.1%, a homocysteine level of 14 µmol/L, an ESR of 37 mm/hour and an erythropoietin level of 12 mU/mL. A repeat bone marrow biopsy revealed mild hypercellularity due to erythroid hyperplasia and megaloblastic changes in the erythroid lineage. Ophthalmic analysis indicated thyroid eye disease, based on findings of conjunctival chemosis, lower lid retraction, engorgement of the medial rectus insertions and severe symmetric proptosis. A predominance of periocular fat was seen on an orbital MRI scan. Treatment with rosiglitazone was discontinued. The woman’s anaemia resolved within 3 weeks, followed by resolution of leucopenia. She experienced a partial improvement in proptosis, and reported pain relief and less ocular pressure within 3 months. There has been no change in her HbA1c level. Clevidence DE, et al. Marrow suppression with myelodysplastic features, hypoerythropoetinemia, and lipotrophic proptosis due to rosiglitazone. Wisconsin 803013985 Medical Journal 108: 462-5, No. 9, Dec 2009 - USA
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Reactions 22 May 2010 No. 1302
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