Fatal agranulocytosis attributable to cimetidine

Area of Science:

• Hematology
• Pharmacology
• Gastroenterology

Background:

• Cimetidine is a histamine H2 receptor antagonist used to decrease gastric acid production.
• Previous reports indicate a rare association between cimetidine use and hematologic abnormalities, including agranulocytosis and pancytopenia.

Observation:

• A 74-year-old male patient with renal failure was treated with cimetidine for peptic esophagitis.
• Twenty-one days after initiating cimetidine therapy, the patient developed severe granulocytopenia.

Findings:

• The patient's severe granulocytopenia progressed rapidly.
• This hematologic complication led to fatal septicemia.

Implications:

• This case highlights a potentially life-threatening adverse effect of cimetidine, emphasizing the need for vigilance in patients with risk factors.
• Clinicians should consider monitoring blood counts in patients receiving cimetidine, especially those with compromised renal function or other risk factors for hematologic toxicity.