Letter to the Editor

Methimazole-Induced Severe Febrile Neutropenia Responding to Recombinant Human Granulocyte Colony Stimulating Factor

Authors: Fadi I. Jabr, MD

Abstract

To the Editor:


A 42-year-old woman presented with fever, sore throat, and odynophagia lasting 7 days. She also developed pustules on her right hand after a minor laceration. Her medical history included Graves disease, for which methimazole was initiated 3 months prior. Physical examination revealed whitish patches over the oropharyngeal mucosa, mild, nonpainful cervical lymphadenopathy, and two pustules over her right hand. The pustules were incised and drained. A throat swab showed a negative rapid streptococcus test and a positive monospot test. Blood data revealed white blood cells (WBC) at 700/mm3, neutrophils at 2%, and lymphocytes at 82%. Three weeks earlier, the patient’s WBC count was 6,200/mm3 and her neutrophils were 71%. A lumbar puncture revealed normal cerebrospinal fluid protein and glucose, with three nucleated cells with 58% lymphocytes and 42% monocytes, as well as a negative Gram stain and culture. The urine, throat swab, and blood cultures were negative. Chest radiographs were normal.

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References

1. Tamai H, Mukuta T, Matsubayashi S, et al. Treatment of methimazole-induced agranulocytosis using recombinant human granulocyte colony-stimulating factor (rhG-CSF). J Clin Endocrinol Metab 1993;77:1356–1360.
 
2. Tajiri J, Noguchi S, Murakami, et al. Antithyroid drug induced agranulocytosis: the usefulness of routine white blood cell count monitoring. Arch Intern Med 1990;150:621–624.
 
3. Weitzman SA, Stossel TP. Drug-induced immunological neutropenia. Lancet 1978;20: 1068–1072.