Case Report: Voglibose-induced persistent leukopenia in a patient with type 2 diabetes

While alpha-glucosidase inhibitors like voglibose are generally considered safe, hematological adverse effects such as leukopenia are exceedingly rare. This case report investigates a potential causal link between long-term voglibose use and persistent leukopenia in a diabetic patient, emphasizing the importance of considering drug-induced cytopenia in unexplained leukopenia.

We describe a 71-year-old male with well-controlled type 2 diabetes who developed leukopenia over five years. After extensive evaluation, including bone marrow biopsy showing hypoplasia, and ineffective leukopoietic treatment, a multidisciplinary review identified long-term voglibose use as a possible cause. The drug was replaced with acarbose.

Two weeks after switching to acarbose, the patient's white blood cell count rose from a persistent range of 2.69-3.32 × 10⁹/L to 3.89-3.98 × 10⁹/L, without other interventions. The temporal association and a Naranjo score of 7 supported voglibose as the probable cause of leukopenia.

This case suggests that voglibose may rarely induce chronic leukopenia, especially with prolonged use. In diabetic patients with unexplained cytopenia, clinicians may consider medication review and therapeutic substitution as a diagnostic and management strategy.