Methimazole-Induced Concomitant Agranulocytosis and Cholestasis in a Young Female
| Autor: | Ambika Amblee, Ayokunle T. Abegunde, Milli Jain |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Bilirubin Graves' disease 030204 cardiovascular system & hematology Neutropenia Gastroenterology Diseases of the endocrine glands. Clinical endocrinology 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Cholestasis Internal medicine Medicine 030212 general & internal medicine business.industry General Medicine Jaundice medicine.disease RC648-665 Endocrinology Carbimazole chemistry Concomitant Absolute neutrophil count medicine.symptom business medicine.drug |
| Zdroj: | AACE Clinical Case Reports, Vol 2, Iss 3, Pp e210-e213 (2016) |
| ISSN: | 2376-0605 |
| Popis: | Objective: To report a case of methimazole (MMI)-induced agranulocytosis and cholestasis in a patient with Graves disease.Methods: Case-based review of thionamide-induced concomitant agranulocytosis and hepatotoxicity. We performed a PubMed search using the search terms methimazole, carbimazole (CBZ), thionamides, agranulocytosis, hepatotoxicity, and cholestasis.Results: A 31-year-old female with newly di agnosed hyperthyroidism presented to our hospital with fever, odynophagia, and jaundice 8 weeks after she was started on MMI. Physical examination was significant for scleral icterus, tremors, and generalized hyperreflexia. Laboratory tests revealed marked neutropenia; her absolute neutrophil count (ANC) was 24, total bilirubin 3.1 (0.2–1.2 mg/dL), direct bilirubin 1.4 (0–0.2 mg/dL), and free thyroxine had trended down from 3.6 (0.58–1.64 ng/dL) at diagnosis 2 months earlier to 2.27 on admission. MMI was discontinued, and antibiotics and granulocyte colony-stimulating factor (G-CSF) were started. A bone marrow (BM) biopsy revealed hypercellularity and trilineage hematopoiesis with left-shifted myeloid maturity. Total serum bilirubin decreased 24 hours after stopping MMI and normalized by day 7 of admission. ANC started rising on day 6 and normalized on day 9. Diagnostic radioactive iodine (RAI) uptake was high (64%), and she received therapeutic RAI treatment the following week with improvement in her clinical condition.Conclusion: Concomitant agranulocytosis and cholestasis is a rare complication of antithyroid drugs (ATDs). To date, only 3 other such cases have been reported in the literature; 2 with use of CBZ and 1 with MMI. This case underscores the importance of remaining vigilant for adverse effects of ATD treatment.Abbreviations: ANC = absolute neutrophil count ATD = antithyroid drugs BM = bone marrow CBZ = carbimazole G-CSF = granulocyte colony-stimulating factor MMI = metimazole PTU = propylthiouracil |
| Databáze: | OpenAIRE |
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