INTRODUCTION: Amiodarone is associated with several adverse effects, including hematologic side effects such as pancytopenia, hemolytic anemia and aplastic anemia. Very few cases of amiodarone-induced bone marrow granulomas have been reported.

METHODS: We report 2 cases of amiodarone-induced bone marrow granulomas. Patient 1: 81-year-old male presented with leukopenia, thrombocytopenia, and hepatosplenomegaly after 2 years of amiodarone. Patient 2: 80-year-old male presented with pancytopenia 2 ½ years after starting amiodarone. Examination was unrmarkable. Bone marrow biopsies on both patients showed non-caseating granulomas with negative stains for acid-fast bacilli and fungi. Both had normal CBC before amiodarone therapy. The literature was reviewed for amiodarone-induced bone marrow granulomas on MEDLINE.

RESULTS: There are 8 cases of amiodarone-induced bone marrow granulomas in the literature. Male: female - 5:3. One also had amiodarone-induced hepatic granulomas. Amiodarone was stopped in 5 cases with the improvement of granulomas in 3 cases. Patient characteristics and outcomes are shown below.

RefAge/SexCBC/Chemistry abnormalitiesAssociated blood disordersAmiodarone stoppedoutcome/Note
Boutros et al 67M none MGUS Yes fewer granulomas in bone marrow 
Boutros et al 77F platelet ↓ none Yes platelet count normalized and fewer granulomas in bone marrow 
Rosenbaum et al 53/F WBC ↑, Platelet ↑ myelofibrosis No also has amiodarone-induced hypothyroidism 
Rosenbaum et al 78/F RBC ↓  Yes Doing well. CBC unknown 
Mukhopadhyay et al 81/M RBC ↓ MDS No Erythropoetin improved anemia 
Mukhopadhyay et al 62/M pancytopenia none No Also has splenomegaly. CBC stable 
Yamreudeewong et al 63/M Unknown none Yes Bone marrow biopsy performed for fever of unknown origin. Symptoms improved. 
Moran et al 76/M RBC ↓, LFT ↑ MGUS Yes Bone marrow granulomas resolved. Liver biopsy showed granulomas. 
Our patient 1 81/M WBC ↓, Platelet ↓ none Yes Also has amiodarone-induced hyperthyroidism. Hepatosplenomegaly and CBC stable 
Our Patient 2 80/M Pancytopenia none No Erythropoetin improved anemia 
RefAge/SexCBC/Chemistry abnormalitiesAssociated blood disordersAmiodarone stoppedoutcome/Note
Boutros et al 67M none MGUS Yes fewer granulomas in bone marrow 
Boutros et al 77F platelet ↓ none Yes platelet count normalized and fewer granulomas in bone marrow 
Rosenbaum et al 53/F WBC ↑, Platelet ↑ myelofibrosis No also has amiodarone-induced hypothyroidism 
Rosenbaum et al 78/F RBC ↓  Yes Doing well. CBC unknown 
Mukhopadhyay et al 81/M RBC ↓ MDS No Erythropoetin improved anemia 
Mukhopadhyay et al 62/M pancytopenia none No Also has splenomegaly. CBC stable 
Yamreudeewong et al 63/M Unknown none Yes Bone marrow biopsy performed for fever of unknown origin. Symptoms improved. 
Moran et al 76/M RBC ↓, LFT ↑ MGUS Yes Bone marrow granulomas resolved. Liver biopsy showed granulomas. 
Our patient 1 81/M WBC ↓, Platelet ↓ none Yes Also has amiodarone-induced hyperthyroidism. Hepatosplenomegaly and CBC stable 
Our Patient 2 80/M Pancytopenia none No Erythropoetin improved anemia 
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CONCLUSION: Bone marrow granulomas, although rare, should be considered as a differential diagnosis in patients on amiodarone presenting with cytopenias.

Topics:
amiodarone, bone marrow, granuloma, pancytopenia, adverse effects, anemia, bone marrow biopsy, erythropoietin, hepatosplenomegaly, monoclonal gammopathy of undetermined significance

Author notes

Corresponding author

2005, The American Society of Hematology
2005
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