ArticleFrontiers in allergy2026
Case Report: Qizhi Yishen Capsule-induced bone marrow granulomas and severe myelosuppression.
Article in Frontiers in allergy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Drug-induced bone marrow injury is an under-recognised adverse drug reaction (ADR) that can present with fever, cytopenias, and eosinophilia. Drug-induced bone marrow granuloma formation remains exceedingly rare among ADRs, and to our knowledge, no such cases associated with traditional Chinese medicine (TCM) formulations have been previously reported. Case presentation: A 79-year-old woman with chronic kidney disease (CKD) developed fever and marked eosinophilia after six weeks of treatment with Qizhi Yishen Capsule, a sinomenine-containing TCM formulation. She rapidly progressed to agranulocytosis and pancytopenia. Bone marrow biopsy revealed non-caseating granulomas with severe myelosuppression and grade 3 fibrosis. Immunohistochemistry showed CD3⁺ T-cell predominance within granulomas with CD20⁺ B cells absent. The Naranjo score was 7 (probable ADR). Treatment with glucocorticoids and granulocyte colony-stimulating factor (G-CSF) resulted in complete hematologic recovery. Conclusion: This case documents bone marrow granulomas and severe myelosuppression following Qizhi Yishen Capsule administration, a sinomenine-containing TCM formulation. A Naranjo score of 7 (probable) and immunohistochemical evidence of CD3⁺ T-cell infiltration within the granulomata support a drug-related, cell-mediated pathogenesis. Clinicians should consider drug-induced bone marrow toxicity in patients receiving this formulation, particularly those with CKD.
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