目的： 本文報告一位全身性紅斑狼瘡(systemic lupus erythematosus, SLE)患者，疑似因ganciclovir引起全血球減少症。
案例說明：一位45歲女性，疑似巨細胞病毒(cytomegalovirus, CMV)感染肺炎入院，使用ganciclovir 250 mg q12h治療後，發生全血球減少症，給予血液透析合併recombinant human granulocyte colony-stimulating factor (rhG-CSF) 300 μg qd治療後死亡。
討論： Ganciclovir主要用於CMV引起的感染疾病，腎功能不佳的患者需依肌酸酐清除率調整劑量，引起血液方面常見副作用包括貧血、白血球減少症、嗜中性白血球減少症及血小板減少症，較少造成全血球減少症。可能導致的因素與其劑量、腎功能不佳及骨髓抑制等有關。依據Naranjo不良反應與藥物相關性之評估，ganciclovir引起全血球減少症屬於極有可能的。
結論： Ganciclovir引起的血液方面副作用發生率與其使用劑量高低有關，特別是用於腎功能不佳的患者，使用此藥物時須根據肌酸酐清除率調整劑量，應密切監測血液相關數值。
 

Objective: To report a systemic lupus erythematosus case of ganciclovir related pancytopenia.
Case summary: A 45-year-old female patient with cytomegalovirus (CMV) pneumonia was admitted to emergency room. She was given an infusion of 250 mg q12h ganciclovir for cytomegalovirus infection. Pancytopenia developed at drugs therapy, and hemodialysis was treated with 300 μg qd of recombinant human granulocyte colony-stimulating factor (rhG-CSF).

Discussion: Ganciclovir is used for cytomegalovirus infectious diseases. Thus, its dosage needs to be adjusted with respect to patients with renal insufficiency. The hematologic toxicity includes anemia, leucopenia, neutropenia and thrombocytopenia; however, pancytopenia is rarely included. Associated factors of toxicity include dosage, renal dysfunction and bone marrow inhibition. Based on Naranjo adverse reaction probability scale criteria, ganciclovir was the most probable cause of death in patients (score of 5).
Conclusion: Ganciclovir induced haematological adverse effects, relating to dosage increment and reduction, especially in patients with renal insufficiency. Its dosage needs to be adjusted with respect to creatinine clearance and it is recommended to frequently monitor the performance of complete blood counts and platelet counts.