title: Aplastic anemia associated with initiation of nizatidine therapy in a hemodialysis patient.
abstract: We report on a hemodialysis (HD) patient in whom fatal aplastic anemia developed after the administration of nizatidine, a histamine 2 (H2)-receptor antagonist. The patient was a 55-year old Japanese woman and had been on HD for 2 years due to endstage diabetic nephropathy. The patient had a hemorrhagic duodenal ulcer and had been treated with lansoprazole, a proton pump inhibitor, for 2 months. After improvement, lansoprozole was discontinued and she was subsequently treated with nizatidine. Twelve days after initiation of nizatidine treatment, the patient developed a high-grade fever with symptoms suggestive of upper respiratory infection. Hematological tests showed severe pancytopenia, and drug-induced aplastic anemia was diagnosed. Nizatidine was suggested as the causal drug. Despite intensive therapies, the patient died on the 23rd hospital day from generalized fungal infections. Although hematological adverse events have been reported in HD patients receiving H2-receptor antagonists, few studies of fatal aplastic anemia associated with these drugs have been reported. This case emphasized that careful observation is required after the initiation of H2-receptor antagonist treatment in HD patients.
authors.affiliation: Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma 371-8500, Japan.
authors.forename: Takako
authors.initials: T
authors.lastname: Nakano
authors.forename: Takashi
authors.initials: T
authors.lastname: Kuroiwa
authors.forename: Yuki
authors.initials: Y
authors.lastname: Tsumita
authors.forename: Yoriaki
authors.initials: Y
authors.lastname: Kaneko
authors.forename: Keiju
authors.initials: K
authors.lastname: Hiromura
authors.forename: Kazue
authors.initials: K
authors.lastname: Ueki
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nojima
mesh_terms: D000741:Anemia, Aplastic / Q000139:chemically induced*; D004381:Duodenal Ulcer / Q000188:drug therapy* / Q000209:etiology; D017809:Fatal Outcome; D005260:Female; D006635:Histamine H2 Antagonists / Q000009:adverse effects*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008875:Middle Aged; D016567:Nizatidine / Q000009:adverse effects*; D006435:Renal Dialysis
chemical_list: D006635:Histamine H2 Antagonists; D016567:Nizatidine