PANCYTOPENIA ASSOCIATED WITH 5-AMINOSALICYLIC ACID USE IN A PATIENT WITH CROHNS-DISEASE

We report a case of pancytopenia in a 23-year-old man with Crohn's dis ease who was treated with 5-aminosalicylic acid (Pentasa; Nisshin, Tok yo, Japan) 3.0g/day. He developed fever, nausea, diarrhea, and malaise and stopped taking on the third day after commencing Pentasa. Ten day s after withdrawal of Pentasa, he was admitted to hospital because of worsening symptoms. Hematologic evaluation disclosed pancytopenia: red blood cells 283 x 10(4)/mm(3); white blood cells 700/mm(3); and plate lets 8000/mm.(3) Other per tinent laboratory data, including liver and renal function tests results, serology for virus infection, and serum levels of vitamin B12 and folic acids, were normal. Bone marrow exami nation showed a generalized hypocellular picture, suggestive of drug-i nduced bone marrow suppression. He received blood transfusion and reco mbinant human granulocyte colong-stimulating factor (filgrastim). The leucopenia and thrombocytopenia resolved on the 7th and 13th days of h ospitalization, respectively. The anemia continued because of bloody s tool caused by Crohn's disease. However, reticulocytes were markedly i ncreased in number on the 13th day of hospitalization. He is well at 9 months follow-up. Excluding other causes, Pentasa-associated pancytop enia was considered. The increasing use of this agent is expected, bec ause of the increasing number of patients with inflammatory bowel dise ase. Careful clinical and hematological monitoring should be performed , especially for the first 3 months, in patients beginning treatment w ith Pentasa. The drug should be withdrawn immediately if there is a su spicion of blood disorders.