Received Sep 5, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| PNC20 | PNEUMO (PREVNAR20) | PFIZER\WYETH | 1 | LX4486 | IM / LA |
large rash on L arm 5 days post injection, then fever 7 days post, then presented to ER with severe neutropenia/agranulocytosis (ANC=0), autoimmune hemolytic anemia, mild thrombocytopenia. Hospitalized for neutropenic fever, MRSA pharyngitis. bone marrow biopsy shows hypocellular marrow without malignancy. At time of this report still ANC of zero (7 days post initial diagnosis). Of note patient was on methimazole 2.5 mg BID at time of reaction, but had been on this for more than 5 years. Also was taking chinese medical mushroom extract (exact ingredients unknown).
None
Grave's disease
Methimazole 2.5 mg BID, atorvastatin 10 mg daily, non traditional medicine (mushroom extract)
NA
Lab 08/29/25 1858 WBC 0.72* (0% neutrophils, 0% basophils) HGB 11.2* HEMATOCRIT 33.9* PLATELET COUNT 123* FINAL PATHOLOGIC DIAGNOSIS: A-E. Bone Marrow, Left Posterior Iliac Crest (Peripheral Smear, Aspirate Smears, Clot Sections, Core Biopsy Sections): - Variably hypocellular marrow with relative erythroid hyperplasia and blasts less than 5%; see comment - Rare nonparatrabecular lymphoid aggregate, non-specific - Marked polytypic plasmacytosis (30%) and slightly increased hematogones COMMENT The bone marrow is variably hypocellular for the patient�s age, and shows multilineage maturation with marked relative erythroid hyperplasia and no excess of blasts. Morphologic evaluation is limited by the paucicellular, hemodiluted aspirate smears, which show few hematopoietic elements with predominance of erythroid precursors demonstrating left shift and mild dyserythropoiesis, including megaloblastoid-type changes. Additionally, there is marked polytypic plasmacytosis, as well as increased numbers of hematogones, suggesting a reactive/regenerative marrow state, possibly secondary to prior injury and/or infection. Further correlation with additional clinical and serologic/laboratory findings, as well as with results of pending cytogenetic studies, is recommended for final interpretation, and to determine appropriate follow-up.