Antinuclear antibody (ANA) test was positive (1:1000, speckled pattern), while anti-dsDNA, anti-SS-A, anti-SS-B, anti-SM, anti-SCL-70, and anti-Jo-1 antibodies were most negative. be aware of this adverse effect even though it is very rare. Open in a separate window Intro Proton pump inhibitors (PPIs) are widely used medications for treatment of gastric acidCrelated diseases [1, 2]. With the increasing use of PPIs, a series of complications and adverse effects have emerged [3, 4]. Blood dyscrasias are rare adverse Febuxostat D9 effects. Although some instances of cytopenia associated with PPI treatment have been reported, bi-cytopenia has not been documented Febuxostat D9 [5C8]. Here, we statement the 1st case of myelosuppression induced by PPI use, which caused both leukopenia and thrombocytopenia. Case Statement An 85-year-old Chinese Eptifibatide Acetate man was admitted to our hospital because of dysphagia in late June 2017. His medical history included transurethral resection of prostate for benign prostatic hyperplasia in 2012 and percutaneous vertebroplasty for lumbar vertebral compression fracture in 2015. He did not take any medicine when he was at home. The patient underwent endoscopic multi-band mucosectomy for resection of an early squamous cell carcinoma of the esophagus at 21?months previously in another hospital, and subsequently developed progressive dysphagia. He received four endoscopic dilations, and the dysphagia recurred soon after dilation each time. The exact results of examination and the details of treatment in the other hospital were unclear. He was able to swallow only liquids when he came to our hospital. After admission to our hospital, a physical examination revealed that he weighed 60?kg, with a body mass index of 18.4, and had stable vital indicators. No superficial lymph nodes were palpable. Abdominal examination revealed a soft, non-tender stomach without hepatosplenomegaly. A complete blood count showed moderate anemia with slightly reduced serum ferritin and iron concentrations (white blood cell count 5.6??109/L, neutrophil count 4.46??109/L, red Febuxostat D9 blood cell count 2.97??1012/L, hemoglobin 104?g/L, platelet count 135??109/L, serum iron 5.70?mol/L, transferin saturation 16.72%, total iron binding capacity 34.10?mol/L). Iron deficiency anemia caused by malnutrition was suspected. Iron sucrose was administered intravenously and intermittently (100?mg, three times a week, intravenous infusion). Iron sucrose was halted due to short hospital Febuxostat D9 stay and shortage of medicine in the nursing home, with a total dose of 300?mg. An esophagoscopy and esophagogram revealed a 2-mmlong benign scar stricture. A stent was placed after dilation. Dysphagia was alleviated, and the patient was released from the hospital. The stent was dislodged from its proper location after 1?month, and dysphagia had recurred. The stent was removed and an additional balloon dilation was performed in August 2017. Dysphagia was improved markedly, but repeated half to 1 1?month after each dilation. The man was hospitalized later in September and December 2017 for another two dilations. Pantoprazole sodium (80?mg, twice daily, intravenous infusion) was administered each time when he was in hospital, while esomeprazole (20?mg/day, orally) was administered intermittently when he was at home. He came back to our hospital for the fourth balloon dilation on December 2017. Pantoprazole sodium was given again from Febuxostat D9 hospital day 3. A relatively obvious decrease in platelets (from 135??109/L, checked when he first entered our hospital in June, to 83??109/L) was found on hospital day 5. After 4?days of pantoprazole administration, neutropenia (white blood cell count from 5.6??109/L, checked when he first entered our hospital in June, to 2.67??109/L; neutrophil count from 4.46??109/L, checked when he first entered our hospital in June, to 0.88??109/L) was observed on hospital day 7. In a review of his previous medical history, we found a pattern of slight decrease in white blood cells and neutrophils since his first admission to our hospital. Further examinations.