Abstract
The best-known adverse hematologic reaction of methimazole is agranulocytosis. Aplastic anemia is extremely rare. The prognosis within the entity of aplastic anemias is surprisingly good, despite the severe and prolonged course of the disease. The present article reports the case of a 74-yr-old female patient who exhibited aplastic anemia with severe clinical symptoms 8 weeks after the initiation of methimazole administration. The hemorrhagic symptoms were aggravated by a coumarin overdose. Supportive hemotherapy and antibiotic treatment were supplemented with recombinant human granulocyte colony-stimulating factor and high-dosage corticosteroids. The granulocyte count normalized on day 5 of treatment, the platelet count exceeded the critical value on day 11, and on day 25 the patient was discharged in remission.
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References
Bartalena L, Bogazzi F, Martino E. Adverse effects of thyroid hormone preparations and antithyroid drugs. Drug Saf 1996, 15: 53–63.
Meyer-Gessner M, Benker G, Lederbogen S, Olbricht T, Reinwein D. Antithyroid drug-induced agranulocytosis: clinical experience with ten patients treated at one institution and review of the literature. J Endocrinol Invest 1994, 17: 29–36.
Edell SL, Bartuska DG. Aplastic anemia secondary to methimazole-case report and review of hematologic side effects. J Am Med Womens Ass 1975, 30: 412–3.
Bishara J. Methimazole-induced aplastic anemia. Ann Pharmacother 1996, 30: 684.
Biswas N, Ahn You-Hern, Ahn JM, Schwartz JM. Case report: aplastic anemia associated with antithyroid drugs. Am J Med Sci 1991, 301: 190–4.
McClellan JE, Wallingford WR. Aplastic anemia due to methimazole. Va Med Mo 1976, 103: 354–55.
Moreb J, Shemesh O, Shilo S, Manor C, Manor C. Transient methimazole-induced bone marrow aplasia: in vitro evidence for a humoral mechanism of bone marrow suppression. Acta Haematol 1983, 69: 127–31.
López-Karpocitch X, Ulloa-Aguirre A, von Eiff C, Hurtado-Monroy R, Alanis A. Treatment of methimazole-induced severe aplastic anemia with recombinant human granulo-cyte-monocyte colony-stimulating factor and glucocorticos-teroids. Acta Haematol 1992, 87: 148–50.
Escobar-Morreale HF, Bravo P, Garcia-Robles R, Garcia-Larana J, de la Calle H, Sancho J. Methimazole-induced severe aplastic anemia: unsuccessful treatment with recombinant human granulocyte-monocyte colony-stimulating factor. Thyroid 1997, 7: 67–70.
Mezquita P, Luna V, Munoz-Torres M, et al. Methimazole-induced aplastic anemia in third exposure: successful treatment with recombinant human granulocyte colony-stimulating factor. Thyroid 1998, 8: 791–4.
Costa JJ. Updates on cells and cytokines. J Allerg Clin Immunol 1998, 101: 1–6.
Babior BM, Golde DW. Production,distribution, and fate of neutrophils. In: Beutler E, Lichtman MA, Coller BS, Kipps TJ, Seligsohn U eds. William’s Haematology, 6th ed. New York: McGraw-Hill. 2001, 753–9.
Ahmad A. Comparison of recombinant granulocyte colonystimulating factor, recombinant human granulocyte-macro-phage colony-stimulating factor and placebo for treatment of septic preterm infants. Pediatr Infect Dis J 2002, 21: 1061–5.
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Jakucs, J., Pocsay, G. Successful treatment of methimazole-induced severe aplastic anemia with recombinant human granulocyte colony-stimulating factor and high-dosage steroids. J Endocrinol Invest 29, 74–77 (2006). https://doi.org/10.1007/BF03349180
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DOI: https://doi.org/10.1007/BF03349180