Antithyroid Drug-induced Agranulocytosis Complicated by Pneumococcal Sepsis and Upper Airway Obstruction

Abstract

Streptococcus pneumoniae is a rare pathogen of sepsis in patients with antithyroid drug-induced agranulocytosis. We herein describe a case of antithyroid drug-induced agranulocytosis complicated by pneumococcal sepsis and upper airway obstruction. A 27-year-old woman who was previously prescribed methimazole for nine months presented with a four-day history of a sore throat. She nearly choked and was diagnosed with febrile agranulocytosis. She was successfully treated with intubation, intravenous antibiotics and granulocyte colony-stimulating factor. Her blood cultures yielded S. pneumoniae. Emergency airway management, treatment of sepsis and the administration of granulocyte colony-stimulating factor can improve the clinical course of antithyroid drug-induced pneumococcal sepsis in patients with airway obstruction.

Disease indicators for sepsis and analysis of sepsis treatment in children using the continuous blood purification technique

“…Sepsis is a systemic inflammatory response syndrome (SIRS), which is the number one cause of intensive care unit deaths and a serious problem in adult and pediatric critical care medicine (Ishimaru et al, 2013). In recent years, morbidity associated with sepsis has been rising annually.…”

Patient Knowledge of Antithyroid Drug-Induced Agranulocytosis

“…Review of the literature of reported cases of agranulocytosis between 1999 and 2013 identified 80 cases where the presenting symptoms were described [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37]. Fever (93.8%), sore throat (68.7%) and chills (21.2%) were the commonest presenting symptoms.…”

NADPH Oxidase 3: Beyond the Inner Ear

“…Plantinga et al investigated genetic variants associated with susceptibility to agranulocytosis [1056]. Agranulocytosis is defined as a reduced concentration of granulocytes in peripheral blood (<500 granulocytes/mL blood) [1057,1058]. Agranulocytosis can be induced by various factors, such as anti-psychotic drugs [1059] or antibiotics [1060,1061], but is also observed in rare events (0.1-0.35%) in patients during treatment with thionamides to medicate hyperthyroidism [1062][1063][1064].…”

“…Agranulocytosis can be induced by various factors, such as anti-psychotic drugs [1059] or antibiotics [1060,1061], but is also observed in rare events (0.1-0.35%) in patients during treatment with thionamides to medicate hyperthyroidism [1062][1063][1064]. This anti-thyroid drug-induced agranulocytosis (ATDAC) can be a life-threatening condition [1058,1065], especially after the usage of higher doses of anti-thyroid drugs [1066]. During the conducted GWAS of Plantinga et al, two independent families and six patients with Graves' disease (GD) that developed ATDAC during treatment were analyzed.…”