{Reference Type}: Case Reports
{Title}: Two Cases of Methimazole-Induced Agranulocytosis With Their Risk Factors.
{Author}: Khine A;Dhillon K;Jo L;Wormser V;Naing S;Mishra S;Khine A;Dhillon K;Jo L;Wormser V;Naing S;Mishra S;
{Journal}: AACE Clin Case Rep
{Volume}: 8
{Issue}: 2
{Year}: Mar-Apr 2022
暂无{DOI}: 10.1016/j.aace.2021.10.005
{Abstract}: <B>UNASSIGNED: </B>Antithyroid drugs, such as methimazole (MMI), are standard therapies for the medical management of thyrotoxicosis. Agranulocytosis is a rare but lethal adverse effect of antithyroid medications. We have reported 2 cases of MMI-induced agranulocytosis with similar risk factors that likely predisposed them to this adverse reaction.<BR><B>UNASSIGNED: </B>Case 1 involved a 71-year-old woman, with a history of Graves disease, who presented with an altered mental status. She was recently discharged on 40 mg of MMI twice daily, and she continued this dose for 2 months. She was readmitted and found to have neutropenic fever in the setting of MMI-induced agranulocytosis. MMI was discontinued, and she was started on filgrastim. Her cell counts gradually improved, and she was subsequently discharged.Case 2 involved a 68-year-old woman, with a history of Graves disease, who presented with severe back pain, nausea, and vomiting. She was recently discharged on 10 mg of MMI twice daily, which was increased to 10 mg 3 times a day. She was readmitted to the hospital because of a septic shock in the setting of pneumonia, colitis, bacteremia, and MMI-induced agranulocytosis. A bone marrow biopsy showed a polyclonal infiltrate with up to 85% plasma cells. Despite treatment with antibiotics, filgrastim, and continuous renal replacement therapy, she ultimately passed away.<BR><B>UNASSIGNED: </B>Although these cases had differing outcomes, they shared similar features and risk factors, including older age, female sex, and relatively higher doses of MMI.<BR><B>UNASSIGNED: </B>Close follow up and awareness of risk factors, such as age, female sex, and higher doses of MMI, may decrease the risk of MMI-induced agranulocytosis and fatal outcomes.