Death Related to Albendazole-Induced Pancytopenia: Case Report and Review

Abstract

Abstract.Albendazole is a benzimidazole with wide spectrum coverage as an antiparasitic drug. Reported side effects have been minimal. We report the case of a patient who died with severe prolonged pancytopenia beginning during the third week of therapy for a pulmonary echinococcal cyst. This case was a 68-year-old man who presented with a large cystic lung mass. His medical history was significant for Child-Pugh class B cirrhosis. A prolonged course of albendazole was initiated. Two weeks later, the patient presented in septic shock with severe pancytopenia. The patient was initially resuscitated, but died after 10 days with no marrow recovery. Autopsy was consistent with albendazoleinduced pancytopenia. This is the third human case of pancytopenia and the first death reported in relation to albendazole-induced pancytopenia. Neutropenia seems to be related more to higher dosage and longer duration of use. Albendazole sulfoxide peak dose and half life are significantly prolonged by liver disease and concomitant administration of certain drugs. The severity and duration of albendazole-induced pancytopenia in this case was likely related to the underlying liver disease. Frequent serial monitoring of blood counts and cessation of medication with any evidence of marrow toxicity in such patients is warranted.

RETRACTED: Management of liver hydatid cysts – Current perspectives

“…Also benzimidazoles have the potential to suppress bone marrow function, and cases of aplastic anemia have been described with both compounds. 32 Finally, benzimidazole compounds carry a risk to the fetus in the first trimester of pregnancy.…”

Presumptive Albendazole Toxicosis in 12 Alpacas

“…3 In humans, idiosyncratic albendazole toxicosis occurs, especially in patients with liver disease, with long-term albendazole therapy used as either an antiparasitic drug to treat hydatid disease or as an antiproliferative drug in the treatment of certain neoplasias. 7,11,12 The dogs and cat in which toxicosis occurred were also treated for several consecutive days for giardiasis. 6,10 The idiosyncratic signs seen in humans, dogs, and cats are similar to those seen in these camelids, and include severe neutropenia, thrombocytopenia, pancytopenia, and GI signs (dogs only).…”

“…6,10 The idiosyncratic signs seen in humans, dogs, and cats are similar to those seen in these camelids, and include severe neutropenia, thrombocytopenia, pancytopenia, and GI signs (dogs only). 6,7,10,11,12 It is unclear why humans and cats do not show evidence of GI lesions of albendazole toxicity, as the proposed mechanism of the toxic effects is theorized to be the antiproliferative activity of the drug. 6,7 The similarity of the bone-marrow lesions in other species receiving long-term albendazole therapy to those seen in the camelids of this report suggests that multiple dosing played an important role in the clinical signs.…”

“…[5][6][7][8][9][10] Albendazole administration to humans causes clinical abnormalities including pancytopenia, neutropenia, and thrombocytopenia, occasionally resulting in death from sepsis secondary to severe neutropenia. 7,11,12 It has also been associated with severe, reversible leukopenia, and thrombocytopenia in dogs and a cat, 6,10 whereas high-dose fenbendazole (2,000 mg/kg PO for 14 days) causes leukopenia and thrombocytopenia in swine. 5 This report describes the clinical and laboratory findings of presumed albendazole toxicosis in 2 alpaca herds.…”

Genotoxic effects of albendazole in patients medicated for cystic echinococcosis

“…1. Metaphase sample of the experimental group Lacey, 1990;Horton, 1997;Pawlowski et al, 2002;Opatrny et al, 2005). However, little information exists about genotoxic effects of albendazole in humans.…”