A rare case report of severe aplastic anaemia caused by long-term use of zidovudine

Abstract

Background Zidovudine is an antiviral drug used to treat acquired immune deficiency syndrome (AIDS). Anaemia is a common adverse effect of zidovudine that usually occurs in the first 2 to 4 weeks of initial treatment. Here, we describe a patient with HIV infection who developed severe aplastic anaemia 11 years after taking zidovudine. To our knowledge, this is the first case of severe aplastic anaemia caused by the long-term use of zidovudine. Case presentation A 28-year-old male patient with AIDS developed severe aplastic anaemia after taking zidovudine for 11 years. The patient went to the emergency department due to weakness and falls. He was diagnosed with severe anaemia because his haemoglobin (Hb) level was 31 g/L and his red blood cell (RBC) count was 0.89 × 10 12 /L. Gastrointestinal bleeding, haematological diseases and autoimmune haemolytic anaemia were ruled out by gastroenteroscopy, stool routine examination and bone marrow puncture biopsy after admission. When the causality of adverse drug reactions was assessed, the Naranjo score of zidovudine was 8, indicating that severe aplastic anaemia was likely related to zidovudine. Given that bone marrow suppression is a side effect of zidovudine, this drug was discontinued. Lamivudine and dolutegravir sodium tablets were subsequently used as antiviral therapies. The patient’s symptoms of anaemia improved with the transfusion of suspended RBCs, oral polysaccharide iron complex capsules and folic acid tablets. After 2 weeks of treatment, the patient’s symptoms of fatigue improved, with a Hb level of 70 g/L and a RBC count of 2.13 × 10 12 /L, which were significantly better than before, and he was discharged. At the follow-up 6 weeks after discharge, the patient’s Hb level was 156 g/L, his RBC count was 4.67 × 10 12 /L, and the anaemia was resolved. Conclusions Zidovudine has bone marrow suppression toxicity, which manifests as anaemia and can occur at any stage of use. Thus, we should not only pay attention to the initial stage of medication but also regularly monitor the patient via routine blood tests in the later stage. If anaemia occurs during the use of zidovudine, physicians should consider the possibility that anaemia is related to the administration of zidovudine and prescribe medication cessation and symptomatic treatment.