[Neuroborreliosis in patient with aplastic anaemia secondary to therapy with ticlopidine]

Aplastic anaemia is a rare but potentially fatal complication of treatment with ticlopidine.

We present a 55-year-old male with aplastic anaemia which developed after 45 days of the therapy with 200 mg ticlopidine to prevent coronary thrombosis. The treatment with ticlopidine was withdrawn and broad spectrum antibiotics as well as transfusion of packed red cells, platelets and G-CSF were administered. Two weeks after the onset of the disease, the number of white blood cells dropped to 0.5 x 10(9)/l, along with drop of both haemoglobin concentration and the number of platelets. At that time, weakness of facial muscles due to bilateral facial nerve paralysis with Bell's phenomenon and after that weakness of muscles of both legs and signs of polyradiculoneuritis were developed. Western blot analysis of blood and liquor showed a high concentration of IgG and IgM antibodies against Borrelia burgdorferi. The treatment with cephtriaxone resulted in normalization of body temperature and gradual recovery of neurological findings. Blood picture became normal two months after the onset of the disease.

The treatment with ticlopidine may result in different haematological complications such as agranulocytosis/ granulocytopaenia, thrombotic trombocytopenic purpura and rarely aplastic anaemia. Due to these complications blood pictures in patients on this therapy should be closely followed up and in case of complications, the treatment with ticlopidine has to be stopped and introduce the therapeutic procedures depending on the sort of the complications and clinical presentation.