Life-Threatening Agranulocytosis Induced by Sinomenine Hydrochloride in Chronic Kidney Disease: A Case Report and Literature Review.

Sinomenine, derived from Sinomenium acutum, is widely used in inflammatory diseases. However, its risk of inducing agranulocytosis is not widely appreciated. We report a life-threatening case in a 40-year-old woman with chronic kidney disease (CKD; baseline estimated glomerular filtration rate [eGFR] as low as 36 mL/min/1.73 m2) who developed severe agranulocytosis (absolute neutrophil count [ANC] < 0.01 × 109/L) following 35 days of sinomenine hydrochloride therapy. Complications included sepsis and acute kidney injury. A bone marrow biopsy confirmed granulocytic hypoplasia. Management consisted of immediate drug cessation, antibiotics, protective isolation, recombinant human granulocyte colony-stimulating factor, and intravenous immunoglobulin. Neutrophil counts fully recovered within 11 days. This case highlights the potential for severe hematological toxicity from all sinomenine preparations and suggests that CKD may be a risk factor. We recommend close monitoring of full blood counts for at least the initial 6 weeks of therapy, with heightened vigilance in patients with renal impairment.