D-Penicillamine Induced Myelotoxicity: A Unique Case.

Area of Science:

• Hematology
• Pharmacology
• Genetics

Background:

• Wilson's disease (WD) is a genetic disorder of copper metabolism.
• D-penicillamine (DPA) is a chelating agent used to treat WD.
• Drug-induced myelotoxicity is a serious adverse effect of some medications.

Purpose of the Study:

• To report a rare case of D-penicillamine-induced myelotoxicity in a patient with Wilson's disease.
• To highlight the clinical presentation and management challenges of this adverse drug reaction.

Main Methods:

• Case report of a 22-year-old male diagnosed with Wilson's disease and treated with DPA.
• Clinical presentation, laboratory findings, bone marrow biopsy, and treatment interventions were documented.
• Exclusion of other causes of pancytopenia, including viral infections and hematological malignancies.

Main Results:

• The patient developed profound pancytopenia after starting DPA therapy.
• Bone marrow biopsy showed hypocellularity and trilineage hypoplasia.
• Despite supportive care and discontinuation of DPA, myelotoxicity persisted, necessitating transfusions and evaluation for bone marrow transplant.

Conclusions:

• D-penicillamine-induced myelotoxicity is a rare but severe complication in Wilson's disease patients.
• This case underscores the importance of vigilant monitoring for hematological toxicity during DPA treatment.
• Further research is needed to establish clear guidelines for managing and mitigating DPA-induced myelotoxicity.