背景:甲基咪唑是一种已知会引起血液学毒性的抗甲状腺药物,包括粒细胞缺乏症,很少,全血细胞减少症.我们在此介绍一例患有Graves病(GD)的患者,该患者发生甲伊咪唑诱导的全血细胞减少症。
方法:一名53岁的秘鲁妇女患有GD,最初用甲咪唑20mgBID治疗,有经验的吞咽困难,发烧,治疗37天后不适。最初的诊断是粒细胞缺乏,导致停止使用甲咪唑和开始使用抗生素。由于持续的中性粒细胞减少,给予粒细胞集落刺激因子(G-CSF)。八天后,她出现了全血细胞减少症,并接受了造血药物和血小板输注治疗。患者的血细胞计数恢复正常,消除了对骨髓(BM)检查的需要。选择放射性碘治疗作为最终治疗,导致甲状腺功能减退。目前,患者甲状腺和血液学稳定。
结论:甲伊咪唑引起的全血细胞减少是一种罕见且严重的并发症;经过适当的治疗,可以实现完全恢复。
BACKGROUND: Methimazole is an antithyroid drug known to cause hematological toxicity, including agranulocytosis and, very rarely, pancytopenia. We herein present a
case of a patient with Graves\' Disease (GD) who developed methimazole-induced pancytopenia.
METHODS: A 53-year-old Peruvian woman with GD, initially treated with methimazole 20 mg BID, experienced odynophagia, fever, and malaise after 37 days of treatment. The initial diagnosis was agranulocytosis, leading to the discontinuation of methimazole and initiation of antibiotics. Due to persistent neutropenia, a Granulocyte Colony-stimulating Factor (G-CSF) was administered. Eight days later, she developed pancytopenia and was managed with hematopoietic agents and platelet transfusions. The patient recovered with normalization of the blood count, eliminating the need for Bone Marrow (BM) examination. Radioiodine therapy was chosen as the definitive treatment, resulting in hypothyroidism. Currently, the patient is thyroidal and hematologically stable.
CONCLUSIONS: Methimazole-induced pancytopenia is a rare and serious complication; however, with appropriate treatment, complete recovery can be achieved.