Pure Red Cell Aplasia in Follicular Lymphoma with Bone Marrow Involvement and Isoniazid Exposure
DOI:
https://doi.org/10.20344/amp.23222Keywords:
Isoniazid/adverse effects, Latent Tuberculosis/drug therapy, Lymphoma, Follicular, Red-Cell Aplasia, Pure/chemically induced, Rituximab/therapeutic useAbstract
Pure red cell aplasia is a rare bone marrow failure syndrome that is often overlooked, as it is potentially associated with other more common diseases. This report describes a 79-year-old man who was referred due to red cell transfusion-dependent anemia, severe reticulocytopenia, and generalized lymphadenopathies. An excisional lymph node biopsy suggested a diagnosis of follicular lymphoma. Trephine biopsy identified areas of lymphoma infiltration and a significant reduction of erythroid precursor cells. The patient was treated with four-weekly doses of rituximab; however, only after suspension of isoniazid treatment for latent tuberculosis was a complete and persistent hematologic recovery achieved. This case highlights the rarely described association between pure red cell aplasia and isoniazid in a patient with simultaneous follicular lymphoma with bone marrow involvement. Recognition of such connections is crucial for accurate diagnosis and appropriate management, as the treatment of lymphoma might not be sufficient as a sole strategy for clinical improvement.
Downloads
References
Sawada K, Fujishima N, Hirokawa M. Acquired pure red cell aplasia: updated review of treatment. Br J Haematol. 2008;142:505-14.
Vlachos A, Farrar JE, Atsidaftos E, Muir E, Narla A, Markello TC, et al. Diminutive somatic deletions in the 5q region lead to a phenotype atypical of classical 5q- syndrome. Blood. 2013;122:2487-90.
Visco C, Barcellini W, Maura F, Neri A, Cortelezzi A, Rodeghiero F. Autoimmune cytopenias in chronic lymphocytic leukemia. Am J Hematol. 2014;89:1055-62.
Sukhera AB, Rodriguez Vazquez J, Erazo G, Ogedegbe OJ, Ntukidem OL, Sanchez A, et al. Association of autoimmune disorders and lymphoma: a population-based cohort study. Blood. 2024;144:6429.
Hirokawa M, Sawada K, Fujishima N, Kawano F, Kimura A, Watanabe T, et al. Acquired pure red cell aplasia associated with malignant lymphomas: a nationwide cohort study in Japan for the PRCA collaborative study group. Am J Hematol. 2009;84:144-8.
Fisch P, Handgretinger R, Schaefer HE. Pure red cell aplasia. Br J Haematol. 2000;111:1010-22.
Handgretinger R, Geiselhart A, Moris A, Grau R, Teuffel O, Bethge W, et al. Pure red-cell aplasia associated with clonal expansion of granular lymphocytes expressing killer-cell inhibitory receptors. N Engl J Med. 1999;340:278-84.
Vlachaki E, Diamantidis MD, Klonizakis P, Haralambidou-Vranitsa S, Ioannidou-Papagiannaki E, Klonizakis I. Pure red cell aplasia and lymphoproliferative disorders: an infrequent association. Sci World J. 2012;2012:475313.
Loulergue P, Mir O, Dhote R. Pure red blood cell aplasia and isoniazid use. Emerg Infect Dis. 2007;13:1427-8.
Azhar W, Zaidi F, Hannan A. Isoniazid induced pure red blood cell aplasia. Cureus. 2020;12:e7112.
Shukla A, Mishra S, Jain M, Tripathi AK. Pure red cell aplasia: a rare complication of isoniazid therapy. Indian J Hematol Blood Transfus. 2014;30:36-7.
Goodman SB, Block MH. A case of red cell aplasia occurring as a result of antituberculous therapy. Blood. 1964;24:616-23.
Kahl BS, Hong F, Williams ME, Gascoyne RD, Wagner LI, Krauss JC, et al. Rituximab extended schedule or re-treatment trial for low-tumor burden follicular lymphoma: eastern cooperative oncology group protocol e4402. J Clin Oncol. 2014;32:3096-102.
Ghazal H. Successful treatment of pure red cell aplasia with rituximab in patients with chronic lymphocytic leukemia. Blood. 2002;99:1092-4.
Auner HW, Wolfler A, Beham-Schmid C, Strunk D, Linkesch W, Sill H. Restoration of erythropoiesis by rituximab in an adult patient with primary acquired pure red cell aplasia refractory to conventional treatment. Br J Haematol. 2002;116:727-8.
Yamamoto G, Maki H, Ichikawa M, Kurokawa M. Pure red cell aplasia with follicular lymphoma showing regression and progression parallel to lymphoma. Int J Hematol. 2011;94:576-7.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Acta Médica Portuguesa
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All the articles published in the AMP are open access and comply with the requirements of funding agencies or academic institutions. The AMP is governed by the terms of the Creative Commons ‘Attribution – Non-Commercial Use - (CC-BY-NC)’ license, regarding the use by third parties.
It is the author’s responsibility to obtain approval for the reproduction of figures, tables, etc. from other publications.
Upon acceptance of an article for publication, the authors will be asked to complete the ICMJE “Copyright Liability and Copyright Sharing Statement “(http://www.actamedicaportuguesa.com/info/AMP-NormasPublicacao.pdf) and the “Declaration of Potential Conflicts of Interest” (http:// www.icmje.org/conflicts-of-interest). An e-mail will be sent to the corresponding author to acknowledge receipt of the manuscript.
After publication, the authors are authorised to make their articles available in repositories of their institutions of origin, as long as they always mention where they were published and according to the Creative Commons license.
