Drug-Induced Bone Marrow Aplasia Revealed by Severe Hemorrhagic Stroke after Taking Amiodarone: A Case Report

Aplastic anemia is defined by the disappearance or rarefaction of the normal hematopoietic tissue of the marrow leading to quantitative bone marrow failure; the diagnosis of aplastic anemia is based on clinicobiological criteria; multiple etiologies may be involved, in particular drug causes, in particular amiodarone. Mrs. SZ, 45 years old; follow-up for VT on ischemic heart disease put on amiodarone for 6 months. Symptoms dated back 2 days before admission with the onset of disturbance of consciousness and generalized tonic-clonic seizures. On admission neurologically: the patient had 9/15 GCS, pupils in tight miosis, no deficit, no convulsion; with a stable hemodynamic and respiratory state The remainder of the examination showed gingivorrhagia with bruising of the lower limbs. Complementary examinations had found: an aspect of a parafalcorial hemorrhagic stroke complicated by major tri ventricular hydrocephalus with ventricular flooding on the CT scan. With pancytopenia: Hb: 6.4g / dl, GB 890e; PNN 30e; Lc: 780e; Pq: 4000e, absence of Blasts, a myelogram and a BOM showed a desert marrow with cytogenetic and molecular study, the rest of the work-up ruled out the other etiologies of AM and the drug etiology was retained. Treatment was mainly symptomatic, administration of tranexamic acid, transfusion of 2 GC of 5 CPQ; management of ACSOS; and discontinuation of the drug. The course was marked by the regression of pancytopenia. The occurrence of aplasia under amiodarone is a fairly rare occurrence. According to the recommendations, the severity criteria are essentially biological; the severity of the aplastic anemia in this patient is determined by the 2 criteria present: PNN less than 500th and the platelets less than 20,000th; the severity of this case is greater given the severe added stroke. Treatment in severe aplasia consists of the administration of immunosuppressants (cyclosporine, high doses of corticosteroid, anti-lymphocytic serum) with 40% remission Or a hematopoietic stem cell transplant with 70% remission.