Background Ketorolac (Toradol) is a non-steroidal anti-inflammatory drug (NSAID) that is commonly used to reduce pain and inflammation. It inhibits prostaglandin synthesis by competitively blocking cyclooxygenase (COX) enzymes. Although Toradol has known adverse side effects to include agranulocytosis, cases of such are extremely rare. Here we present a unique case of severe agranulocytosis following Toradol administration. Case Presentation A 72 year-old male with a past medical history of moderate-severe rheumatoid arthritis on methotrexate, golimumab (Simponi) and prednisone, hypertension and type two diabetes mellitus presented with one week of progressive oropharyngeal dysphagia and odynophagia consistent with severe esophageal candidiasis; he was admitted for treatment with fluconazole. In the 2 days prior to admission, the patient was seen in the emergency room setting on multiple occasions and was administered 75 mg of intramuscular Toradol. His complete blood count (CBC) the day prior to admission was significant for a normal WBC (6.81), a mild anemia (11.5), and a mild thrombocytopenia (145). On the day of admission he received an additional 30 mg of Toradol. The following CBC revealed pancytopenia with a leukopenia of 0.72, anemia of 10.4, and thrombocytopenia of 101. Toradol was discontinued, and his home regimen for rheumatoid arthritis was held the entirety of admission. A broad workup for etiologies of pancytopenia was unrevealing. Viral serologies were negative, hemolytic labs and blood smear showed no signs of hemolysis as well as no blasts. Felty syndrome was also considered but imaging did not show splenomegaly. Additionally, an iron panel, B12 and Folate were normal. Bone marrow suppression was evident by a reticulocyte of 0.27% and a rapid drop in WBC and thus the patient was initiated on Neupogen, a granulocyte colony-stimulating factor, and leucovorin. Bone marrow biopsy and flow cytometry revealed hypercellular/hyperproliferative myeloid elements and low level of blasts (5%) after G-CSF administration. The patient required platelet and blood transfusions on hospital day 6 and counts began to recover shortly after. Patient was discharged after cell lines had returned to safe levels. Discussion In patients who are unable to tolerate oral NSAIDs, Toradol is commonly used. While cytopenias are often seen in the in-patient setting, providers should be aware of potential side effects of NSAIDs including the rarely-seen severe agranulocytosis to allow for early discontinuation of offending medications.