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2019, Number 1

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Rev Cubana Hematol Inmunol Hemoter 2019; 35 (1)

Febrile neutropenia associated with methimazole ingestion: case report

Maestre SRY, Cucunubá-Toloza A, Díaz-Hernández AT, Estrada-Redondo C, Silva-Sanchez O

Language: Spanish
References: 22
Page: 1-9
PDF size: 118.24 Kb.


ABSTRACT

Neutropenia is defined as an absolute neutrophil count less than 1500 cells / μL. It is due to the decrease in the production of granulocytes or increase in their destruction, either at the medullary or peripheral level. According to the classification of the World Health Organization (WHO) the degrees of neutropenia range from 0 to IV, taking into account the magnitude of the decrease in the neutrophil count. Grade IV is the highest risk and corresponds to counts below 500 cells /μL. The impact on morbidity and mortality associated with neutropenia is not linked to the direct reduction of the cell count, but to the associated infectious processes to which patients who present it are prone. There are several conditions under which neutropenia can develop, including infections, malignancies and drugs. The latter can generate adverse effects by dose-dependent mechanisms, as in the case of cytotoxic chemotherapy or an idiosyncratic reaction. Next, the case of a female patient of thirty-seven years of age, with a history of thyrotoxicosis, treated with propanolol and methimazole for four weeks, who in addition to toxic manifestations, presents very severe febrile neutropenia that improves after suspension of the antithyroid. We aim to highlight the association of febrile neutropenia as a complication of thionamide use and the importance of follow-up with laboratory tests for an opportune diagnosis.


REFERENCES

  1. Vicente N, Cardoso L, Barros L, Carrilho F. Antithyroid Drug Induced Agranulocytosis: State of the Art on Diagnosis and Management. Drugs R D. 2017;17(1):91-6.doi: 10.1007/s40268-017-0172-1.

  2. He Y, Li J, Zheng J, Khan Z, Quiang W, Gao F, et al. Emphasis on the early diagnosis of antithyroid drug induced agranulocytosis: retrospective analysis over 16 years at one Chinese center. J Endocrinol Invest. 2017;40(7):733-40. doi: 10.1007/s40618-017-0626-x.

  3. León Morales F, Mateos Toledo H, Caballero Caballero R. Agranulocitosis con plasmocitosis reactiva atípica inducida por metimazol en una paciente con hipertirodismo. Med Int Méx. 2008;24(5):357-60.

  4. Andre`s E , Mourot-Cottet R , Maloisel F , Se´verac F , Keller O, Vogel T, et al. Idiosyncratic drug-induced neutropenia and agranulocytosis. QJM. 2017 Jan 9. pii: hcw220. doi: 10.1093/qjmed/hcw220.

  5. Bukhari S, Khan M, Kumar N, Mohan V. Increased risk for thionamideinduced agranulocytosis in elderly patients: a case presentation and literature review. BMJ Case Rep. 2017 Jul 17;2017. pii: bcr-2017-220924. doi: 10.1136/bcr-2017-220924.

  6. WHO/NMH/NHD/MNM/11.1. Concentraciones de hemoglobina para diagnosticar la anemia y evaluar su gravedad [ Internet] . 2011. [ Citado: 02/08/2017] . Disponible en: http://www.who.int/vmnis/indicators/haemoglobin_es.pdf.

  7. Mark Edy P, Enciso L. Presentación de caso clínico: toxicidad hematológica en una paciente hipertiroidea tratada con metimazol. Acta Med Colomb.2008. (Supl 1):82. [ Citado: 02/08/17] . Disponible en: http://www.actamedicacolombiana.com/anexo/articulos/03S-2008-08.pdf.

  8. Watanabe N, Narimatsu H, Noh JY, Yamaguchi T, Kobayashi K, Kami M, et al. Antithyroid drug induced hematopoietic damage: a retrospective cohort study of agranulocytosis and pancytopenia involving 50.385 patients with Graves’ disease. J. Clin Endocrinol Metab. 2012;97(1):49-53. doi: 10.1210/jc.2011-2221.

  9. Ross DS, Burch HB, Cooper DS. American Thyroid association pautas para el diagnóstico y tratamiento del hipertiroidismo y otras causas de tirotoxicosis. Thyroid 2016; 26(1): 231-72.

  10. Franklyn J. Thyroid gland: Antithyroid therapy best choice of drug and dose. Nature Rev Endocrinol. 2009;5(11):592-4.doi:10.1038/nrendo.2009.201

  11. Maciel ME, Duranona KB. Agranulocitosis adquirida: planteos diagnósticos. Hematología. 2016;20(1):115-8.

  12. Cooper D. Antithyroid Drugs. New Engl J Med. 2005;352:905-17. doi: 10.1056/NEJMra042972

  13. Alvira J, Galván G, Ordoñez J, Parga C. Eficacia y seguridad del metimazol en el tratamiento del hipertiroidismo por enfermedad de Graves en menores de 18 años. Barranquilla, 2013-2015. Biociencias. 2016;11(1):41-7.

  14. Manrique-Hurtado H, Pinto-Valdivia M. Agranulocitosis inducida por metimazol en una paciente con enfermedad de Graves. Rev Med Hered. 2013; 24:109-13.

  15. Tajiri J, Noguchi S. Antithyroid drug induced agranulocytosis: how has granulocyte colonystimulating factor changed therapy? Thyroid. 2005;15(3):292-7. doi:10.1089/thy.2005.15.292

  16. Mourot-Cottet R, Maloisel F, Séverac F, Keller O, Vogel T, Tebacher M, et al. Idiosyncratic Drug-Induced Severe Neutropenia and Agranulocytosis in Elderly Patients (75 years): A Monocentric Cohort Study of 61 Cases. Drugs Real World Outcomes. 2016 Dec;3(4):393-9.

  17. Kim H, Lee J, Ha J. A case of antithyroid drug-induced agranulocytosis from a second antithyroid drugs (ATD) administration in a relapsed Graves' disease patient who was tolerant to the first ATD treatment. Clin Case Rep. 2018 Jul 10;6(9):1701-1703. doi: 10.1002/ccr3.1644

  18. Pick AM, Nystrom KK. Non chemotherapy Drug-Induced Neutropenia and Agranulocytosis: could medications be culprit? J. Pharm. Pract. 2014; 27(5):447-52.doi: 10.1177/0897190014546115.

  19. Johnston A, Uetrecht J. Current understanding of the mechanism of idiosyncratic drug induced agranulocytosis. Expert Opin Drug Metab Toxicol 2015;11:243-257.doi: 10.1517/17425255.2015.985649.

  20. Varışlı B, Yıldırım S, Karaçam H, Paker Ş. Methimazole-induced febrile neutropenia. J Emerg Med Case Rep. 2018; 9: 13-5. doi: 10.5152/jemcr.2018.1851

  21. Klastersky J, De Naurois J, Rolston K, Rapoport B, Maschmeyer G, Aapro M, et al. Management of febril neutropaenia: ESMO Clinical Practice Guidelines. Ann Oncol. 2016; 27(suppl 5): v111-v8. doi:10.1093/annonc/mdw325

  22. Yang J, Zhong J, Xiao XH, Zhou LZ, Chen YJ, Liu JH, et al. The relationship between bone marrow characteristics and the clinical prognosis of antithyroid drug induced agranulocytosis. Endocr J. 2013;60(2):185-9.




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