Ranitidine-induced agranulocytosis in a hemodialysis patient

A 70-year old woman was hospitalized for treatment of leukopenia and a 3-day history of fever and sore throat. Three years before admission the patient had been diagnosed as having interstitial pneumonia and had been treated with steroids. Because of impairment of renal function, regular hemodialysis had been initiated 3 months previously. Two months before admission treatment with steroids was necessitated by exacerbation of the pneumonia. Since 1 month before admission she had been treated with ranitidine, 150mg once a day, for gastritis. Her leukocyte count was 1, 100/mm3 with 0% neutrophils. Bone marrow examination showed granulopoietic hypoplasia. Ranitidine therapy was immediately discontinued and administration of G-CSF was started. One month later, her leukocyte counts had recovered. Since myelosupression due to ranitidine may occur because of impaired excretion, physicians should be alert to this complication.