Amiodarone- Induced Bone Marrow Granulomas.

Abstract

INTRODUCTION: Amiodarone is associated with several adverse effects, including hematologic side effects such as pancytopenia, hemolytic anemia and aplastic anemia. Very few cases of amiodarone-induced bone marrow granulomas have been reported.METHODS: We report 2 cases of amiodarone-induced bone marrow granulomas. Patient 1: 81-year-old male presented with leukopenia, thrombocytopenia, and hepatosplenomegaly after 2 years of amiodarone. Patient 2: 80-year-old male presented with pancytopenia 2 ½ years after starting amiodarone. Examination was unrmarkable. Bone marrow biopsies on both patients showed non-caseating granulomas with negative stains for acid-fast bacilli and fungi. Both had normal CBC before amiodarone therapy. The literature was reviewed for amiodarone-induced bone marrow granulomas on MEDLINE.RESULTS: There are 8 cases of amiodarone-induced bone marrow granulomas in the literature. Male: female - 5:3. One also had amiodarone-induced hepatic granulomas. Amiodarone was stopped in 5 cases with the improvement of granulomas in 3 cases. Patient characteristics and outcomes are shown below.RefAge/SexCBC/Chemistry abnormalitiesAssociated blood disordersAmiodarone stoppedoutcome/NoteBoutros et al67MnoneMGUSYesfewer granulomas in bone marrowBoutros et al77Fplatelet ↓noneYesplatelet count normalized and fewer granulomas in bone marrowRosenbaum et al53/FWBC ↑, Platelet ↑myelofibrosisNoalso has amiodarone-induced hypothyroidismRosenbaum et al78/FRBC ↓YesDoing well. CBC unknownMukhopadhyay et al81/MRBC ↓MDSNoErythropoetin improved anemiaMukhopadhyay et al62/MpancytopenianoneNoAlso has splenomegaly. CBC stableYamreudeewong et al63/MUnknownnoneYesBone marrow biopsy performed for fever of unknown origin. Symptoms improved.Moran et al76/MRBC ↓, LFT ↑MGUSYesBone marrow granulomas resolved. Liver biopsy showed granulomas.Our patient 181/MWBC ↓, Platelet ↓noneYesAlso has amiodarone-induced hyperthyroidism. Hepatosplenomegaly and CBC stableOur Patient 280/MPancytopenianoneNoErythropoetin improved anemiaCONCLUSION: Bone marrow granulomas, although rare, should be considered as a differential diagnosis in patients on amiodarone presenting with cytopenias.