Related Experiment Video
Updated: Aug 6, 2026
Busulfan as a Myelosuppressive Agent for Generating Stable High-level Bone Marrow Chimerism in Mice
Published on: April 1, 2015
Case Report: Qizhi Yishen Capsule-induced bone marrow granulomas and severe myelosuppression
Ping Xie1, Yuting Zhang2, Jinli Jiang1
1Department of Infectious Diseases, Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Background:
Drug-induced bone marrow injury is an under-recognised adverse drug reaction (ADR) that can present with fever, cytopenias, and eosinophilia. Drug-induced bone marrow granuloma formation remains exceedingly rare among ADRs, and to our knowledge, no such cases associated with traditional Chinese medicine (TCM) formulations have been previously reported.
Case Presentation:
A 79-year-old woman with chronic kidney disease (CKD) developed fever and marked eosinophilia after six weeks of treatment with Qizhi Yishen Capsule, a sinomenine-containing TCM formulation. She rapidly progressed to agranulocytosis and pancytopenia. Bone marrow biopsy revealed non-caseating granulomas with severe myelosuppression and grade 3 fibrosis. Immunohistochemistry showed CD3⁺ T-cell predominance within granulomas with CD20⁺ B cells absent. The Naranjo score was 7 (probable ADR). Treatment with glucocorticoids and granulocyte colony-stimulating factor (G-CSF) resulted in complete hematologic recovery.
Conclusion:
This case documents bone marrow granulomas and severe myelosuppression following Qizhi Yishen Capsule administration, a sinomenine-containing TCM formulation. A Naranjo score of 7 (probable) and immunohistochemical evidence of CD3⁺ T-cell infiltration within the granulomata support a drug-related, cell-mediated pathogenesis. Clinicians should consider drug-induced bone marrow toxicity in patients receiving this formulation, particularly those with CKD.
