Carbimazole induced agranulocytosis with life-threatening complications, tremendous response with granulocyte-colony stimulating factor

• Main Authors: Seema Mahant, Upasana Shobhane, P D Mahant
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2016-01-01
• Series: Medical Journal of Dr. D.Y. Patil University
• Subjects: Agranulocytosis; antithyroid agents (carbimazole); granulocyte colony-stimulating factor
• Online Access: http://www.mjdrdypu.org/article.asp?issn=0975-2870;year=2016;volume=9;issue=1;spage=79;epage=81;aulast=Mahant

Agranulocytosis is a rare complication of drug carbimazole (0.23%). We are accounting to present a very interesting and rare case of agranulocytosis and neutropenic sepsis secondary to carbimazole that have tremendous response with recombinant human granulocyte colony-stimulating factor (G-CSF). A 35-year-old woman with hyperthyroidism since 1-month, who developed delayed carbimazole induced agranulocytosis. She presented with a fever, cough, sore throat and painful mouth ulcer since 7 day. Investigations revealed hyperthyroidism with neutropenia, white blood cell of 0.3 × 10 9 (neutrophils of 0.0 × 10 9 /L). Bone marrow aspiration revealed a hypocellular marrow with reduced myelopoiesis with minimal maturation, consistent with drug-induced neutropenia. G-CSF was used as an adjunctive therapy with discontinuation of carbimazole, barrier nursing and a broad-spectrum antibiotic (Third-generation cephalosporins) regimen to treat her neutropenic sepsis. Total white cell count and neutrophil count returned to normal on 5 days treatment and she made an uneventful recovery. She was subsequently rendered euthyroid with radioiodine treatment.