SHM Converge Scientific Abstract ePoster Gallery-Fungi and Humans? What You Need to Know About Terbinafine

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This case report describes a rare but serious adverse effect of oral terbinafine: aplastic anemia with severe pancytopenia. A 42-year-old Hispanic woman with hypothyroidism, iron deficiency anemia, and recurrent onychomycosis developed widespread bruising and petechiae two months after starting terbinafine. She had previously experienced a similar bruising episode while taking the same medication.<br /><br />On admission, she was found to have profound pancytopenia, including hemoglobin 9.2 g/dL, white blood cells 2.1 K/CMM, and platelets 6 K/CMM, with severe neutropenia. Workup excluded other common causes such as bleeding disorders, hemolysis, vitamin deficiencies, viral infections (HIV, hepatitis, EBV, parvovirus), malignancy, and clotting abnormalities. Bone marrow biopsy showed findings consistent with aplastic anemia.<br /><br />Terbinafine was stopped and the patient’s course was complicated by neutropenic fever, severe thrombocytopenia, and worsening anemia requiring multiple transfusions of platelets and packed red blood cells. Because her counts remained profoundly low, she was treated with immunosuppressive triple therapy, including antithymocyte globulin, cyclosporine, and eltrombopag. Her blood counts improved, and she was discharged for outpatient hematology follow-up.<br /><br />The report emphasizes that although terbinafine is commonly used and generally safe for onychomycosis, it can rarely suppress bone marrow and cause aplastic anemia. Clinicians should educate patients about warning signs such as bruising or bleeding and consider serial blood count monitoring in patients on prolonged terbinafine therapy. Early recognition and treatment may improve outcomes.

Asset Subtitle

Farhan Khalid

Meta Tag

Author List Doantrang Du, Farhan Khalid, Husam Bader, Muhammad Saad Anwar, Muhammad Tayyeb, Sai Gaddameedi

Category Clinical Vignettes

Concept Terbinafine

Concept Aplastic Anemia

Concept Pancytopenia

Concept Bone Marrow Suppression

Concept Hematologic Toxicity

Distinguished Non-Finalist

Presenter Organization Monmouth Medical Center

Presenting Author Farhan Khalid

Track Adult

Keywords

terbinafine

aplastic anemia

pancytopenia

bone marrow suppression

onychomycosis

neutropenia

thrombocytopenia

bruising

petechiae

immunosuppressive therapy

Terbinafine

Aplastic Anemia

Pancytopenia

Bone Marrow Suppression

Hematologic Toxicity