Reversible Sideroblastic Anemia Caused by Pyrazinoic Acid (Pyrazinamide®)

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Abstract
While being treated for folate deficiency with 200 ug of folic acid daily, a 22 year old Negro female had a suboptimal reticulocyte response and no increase of hematocrit value. The bone marrow had become normoblastic but was characterized by vacuolization of rubri-blasts and numerous ringed sideroblasts. She was receiving isonico-tinic acid hydrazide [isoniozid] (INH) and pyrazinoic acid (Pyrazinamide) as treatment for tuberculosis. When administration of the latter drug was stopped, a good reticulocytosis occurred, followed by a rise in hematocrit reading. The vacuolated rubriblasts and the ringed sideroblasts disappeared from the bone marrow.