LAUSR

To the Editor: Sertraline, a selective serotonin reuptake inhibitor, is widely used in the treatment of depression, anxiety, and obsessive-compulsive disorder, with common adverse effects such as nausea, headache, dry mouth, diarrhea, insomnia, and dizziness.1 Only a small amount of hematological adverse effects related to sertraline have been reported. We have described here a case of an adult male with neutropenia related to sertraline treatment. A 36-year-old Taiwanese male with a history of type 2 diabetes mellitus complicated with diabetic nephropathy in the end-stage renal disease (ESRD) was admitted to the nephrology ward for fatigue. On admission, leukopenia with white blood cell counts presented only 1780/mL, with neutrophil as 680/mL, comparing with the blood profile 2 days before sertraline usage as white blood cell counts 6610/mL, with neutrophil as 5486/mL. He developed a depressive episode after facing the impending hemodialysis. Sertraline was prescribed in a psychiatric clinic and titrated from 50 mg/d to 100 mg/d within 2 weeks, right before his admission. Other medications included linagliptin 5 mg/d, bisoprolol 2.5 mg/d, doxazosin 2 mg/d, amlodipine 10 mg/d, valsartan 160 mg/d, calcium carbonate 1.5gm/d, and vitamin D 0.25 mg/d. The estimation of Naranjo’s score was 6. We discontinued the sertraline and changed to escitalopram 10 mg/d. The blood profile was rechecked 3 days later and found that the white blood cell count was raised back to 2200/mL, with neutrophil as 948/mL. His fatigue also improved after the antidepressant change. He was discharged the next day and was scheduled to come back to the outpatient department for the white blood cell test a month later. However, he came back to the emergency medicine department due to acute gastritis, and the complete blood cell test at this visit revealed the white blood cell count as 6700/mL, and neutrophil as 6063/mL, which hinted at the recovery of the bone marrow reactivity.