Fatal aplastic anemia following apparent "dose-related" chloramphenicol toxicity.

T H E R E C O o N I T ! O N of ampicillin-resistant Hemophilus influenzae ~ has increased the use of chloramphenicol, particularly in management of invasive infections caused by this bacterium. Bone marrow toxicity, however, is a serious hazard. Based primarily on clinical data, two different bone marrow toxicities have been proposed. Reversible bone marrow suppression is frequent and dose related.-' Idiosyncratic, aplastic (or severely hypoplastic) bone marrow toxicity is rare, usually irreversible, and has a high fatality rate? These lesions are thought to be dist inct? ~ but we observed a patient with certain features of both toxicities. The purpose of this report is to illustrate that aplastic anemia can occur as an end point of "dose-related" bone marrow suppression.