Cardiac left bundle branch block and pancytopenia in anorexia nervosa: higher risk with mirtazapine and pantoprazole? Case report.

A 36-year-old female patient suffering from anorexia nervosa of the restricting type, depression, symptoms of gastro-esophageal reflux and several cardiac abnormalities including left branch block was treated with mirtazapine and pantoprazole. Several hematological abnormalities appeared, i.e., a pancytopenia including a severe leukopenia (neutropenia), erythrocytopenia and a thrombocytopenia, which almost resumed upon discontinuation of medication. This situation of low nutrition represents probably an important risk factor for the development of severe hematological disturbances and cardiac alterations, including left branch block and it complicates pharmacotherapeutic interventions.