Multifaceted Management of Severe Pancytopenia in a Diabetic Patient: A Case of MRSE-Induced Bone Marrow Suppression

Severe pancytopenia presents a multifactorial clinical challenge, particularly in patients with complex comorbidities such as diabetes mellitus (DM) and systemic infections. This case report discusses the management of a 42-year-old male with uncontrolled type 2 DM who developed severe pancytopenia secondary to methicillin-resistant _Staphylococcus epidermidis_ (MRSE)-induced bone marrow suppression. The patient presented with high-grade fever, pancytopenia, and systemic infection, exacerbated by poor glycemic control. Initial management included broad-spectrum antibiotics, blood transfusions, and supportive care. Blood cultures revealed MRSE, prompting targeted antimicrobial therapy with linezolid, which led to significant clinical improvement. Persistent pancytopenia required the use of thrombopoietin receptor agonist eltrombopag, which successfully stimulated platelet production and improved hematopoiesis. Bone marrow biopsy findings confirmed marked hypocellularity with serous atrophy and reactive fibrosis, consistent with chronic inflammatory and infectious processes. The patient’s course highlighted the critical role of hyperglycemia in exacerbating immune dysfunction and the complexities of managing severe infections in diabetic patients. MRSE-induced biofilm formation and immune evasion further contributed to the prolonged inflammatory state and bone marrow suppression. This case underscores the importance of a multidisciplinary approach, involving antimicrobial therapy, supportive care, and novel agents like eltrombopag, in addressing pancytopenia in the setting of chronic infection and comorbidities. It highlights the need for early and accurate diagnostic workup, tailored therapy, and vigilant monitoring to optimize outcomes in critically ill patients with severe pancytopenia.