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Pancytopenia Concurrent With Metabolic Encephalopathy.

Henry Zou¹, Akash Rau¹, Laura Thompson²

¹Family Medicine, Michigan State University College of Human Medicine, Grand Rapids, USA.

|August 28, 2024

Summary

This case study details a rare instance of pancytopenia (low blood cell counts) alongside metabolic encephalopathy in an elderly woman. Prompt recognition and management of dehydration and electrolyte imbalances are crucial for patient outcomes.

Keywords:

dehydration metabolic encephalopathy myelodysplastic syndrome pancytopenia parvovirus b19

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Area of Science:

Internal Medicine
Hematology
Nephrology

Background:

Pancytopenia, a reduction in all blood cell lines, is linked to various conditions but rarely occurs with encephalopathy.
Metabolic encephalopathy, a diffuse brain dysfunction, can arise from systemic metabolic disturbances.

Observation:

An 81-year-old female presented with fatigue and hypersomnolence, exhibiting pancytopenia and metabolic derangements including hypernatremia and alkalemia.
Initial diagnosis included metabolic encephalopathy and acute kidney injury, necessitating fluid resuscitation, electrolyte correction, and medication review.

Findings:

The patient's metabolic encephalopathy resolved with supportive care, while pancytopenia persisted.
Hypotheses for the metabolic encephalopathy include uremia or dehydration secondary to acute kidney injury.
Potential causes for pancytopenia include parvovirus B19 infection or myelodysplastic syndrome.

Implications:

This case underscores the importance of monitoring patients on Sodium-glucose co-transporter-2 (SGLT-2) inhibitors and loop diuretics for dehydration.
Early identification and management of dehydration can prevent severe complications like acute kidney injury and encephalopathy.
Concurrent pancytopenia warrants a thorough investigation into potential infectious or hematologic etiologies.