Successful treatment of methimazole-induced severe aplastic anaemia in a diabetic patient with other co-morbidities

Abstract

SummaryA 55-year-old Filipina with Grave's disease, diabetes, hypertension, bronchial asthma, Parkinson's disease and a history of adverse drug reaction to penicillin consulted due to high-grade fever and sore throat. Patient was diagnosed with aplastic anaemia secondary to methimazole and was treated with high-dose granulocyte colony stimulating factor, thrombopoietin and mesterolone. Antibiotics used included levofloxacin, clindamycin, amikacin and fluconazole. Due to bleeding and slow recovery of blood parameters, 30 units of platelets and 7 units of packed red blood cells were transfused during her 22-day admission. This case presents a life-threatening adverse drug reaction in a patient with co-morbid conditions that complicate recovery and limit one's therapeutic options. BACKGROUND

Methimazole Induced Total Myeloid Aplasia with Delayed Recovery Despite Granulocyte Colony Stimulating Factor (G-CSF): Marrow Progenitor Recovery Kinetics

“…These last two cytopenias could also be secondary to MMI toxicity, as cases presenting with aplastic anemia have been reported [6,18,19]; however, the bone marrow examination in our case only showed mild hypocellularity with no fatty replacement. What is more, other clinical complications could partly account for both the anemia and thrombocytopenia.…”

Granulocyte-Colony-Stimulating Factor Effectively Shortens Recovery Duration in Anti-Thyroid-Drug-Induced Agranulocytosis: A Systematic Review and Meta-Analysis

“…AA is a severe type of hematological damage in which bone marrow stops producing blood cells, resulting in a higher risk of uncontrolled bleeding and infection (5). Although AA seems to be more severe than agranulocytosis, the present study did not focus on it due to a lack of adequate clinical information (6). In fact, hematological damage is caused by not only ATDs but also by GD.…”