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Agranulocytosis Induced by Sinomenine Hydrochloride

Unknown ethiology, Challenging differential diagnosis, Diagnostic / therapeutic accidents, Management of emergency care, Adverse events of drug therapy

Juerong Chen, Bing Zhong, Yong Wang

Department of Rheumatology, Southwest Hospital, Third Military Medical University, Chongqing, China (mainland)

Am J Case Rep 2017; 18:959-962

DOI: 10.12659/AJCR.904519

Available online:

Published: 2017-09-06

BACKGROUND: Sinomenine hydrochloride is an alkaloid that is extracted from the Chinese herbal plant Sinomenium acutum, and is used as a herbal medicine in the treatment or rheumatic disease. This report is the first to describe a case of sinomenine hydrochloride-induced agranulocytosis.
CASE REPORT: A 44-year-old woman with systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) was treated with sinomenine hydrochloride and developed agranulocytosis with a neutrophil count of 0.01×10^9/L. She subsequently developed an opportunistic bacterial infection. Bone marrow aspiration showed a severe reduction in the proportion of mature granulocytes. The patient discontinued sinomenine hydrochloride therapy and was treated with granulocyte colony-stimulating factor (G-CSF) and antibiotics. The patient showed a return to normal granulocyte levels within ten days of discontinuing treatment with sinomenine hydrochloride.
CONCLUSIONS: The findings of this case report show that monitoring of bone marrow function and granulocyte levels should be performed during treatment with sinomenine hydrochloride.

Keywords: agranulocytosis, Opportunistic Infections, Sinomenium