Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 2 3 2018 02 17 63 66 EN Yukihiro Hama Department of Radiology, Edogawa Hospital, Tokyo, Japan. Shoji Koga Department of Urology, Edogawa Hospital, Tokyo, Japan. 2017 10 15 2017 12 27 Radium-223 dichloride (Ra-223) is an alpha-emitting radioisotope that targets osteoblastic metastasis of prostate cancer. For Ra-223, a favorable safety profile has been described. However, here we report a case of a fatal hematologic toxicity following the administration of Ra-223 observed at our hospital. An 80-year-old man with castration-resistant prostate cancer (CRPC) and multiple metastatic bone lesions was treated with Ra-223. He was complicated with systemic edema, constipation, and decline of renal function. One week later, he developed pancytopenia which deteriorated gradually, and died with severe prolonged pancytopenia and pneumonia 4 weeks after administration of Ra-223. Our report demonstrates the risk of fatal hematologic toxicity of Ra-223 even though pretreatment clinical and laboratory findings fulfill the selection criteria. Caution should be paid when prescribing Ra-223 to a patient with systemic edema, constipation, and decline of renal function. https://crcp.tums.ac.ir/index.php/crcp/article/view/141 https://crcp.tums.ac.ir/index.php/crcp/article/download/141/80