October - December 2019, Volume 15, Issue 4

Stumpf MA, Schrut GCA, Ramthun M, Onuma S, Osternack HC

Methimazole-Induced Agranulocytosis and Sepsis: was Thyroid Storm Present or Just Being Mimicked?

Acta Endo (Buc) 2019, 15 (4): 522-525
doi: 10.4183/aeb.2019.522

Introduction. Agranulocytosis induced by thioamides is rare, occurring only in 0.2-0.5% of cases. Case presentation. We present the case of a 45-year-old woman previously diagnosed with Graves’ disease that discontinued the use of methimazole on her own. She attended the Emergency Department presenting fever (40.5¯C), agitation and diaphoresis. A thyroid storm diagnosis was initially thought, but after laboratory results showing neutrophil count near 0.06x109/L, sepsis due to neutropenia seemed the most logical hypothesis. Cephepime was promptly initiated. For thyrotoxicosis management, cholestyramine and atenolol were prescribed. In her second day of hospitalization, subcutaneous granulocyte colonystimulating factor was started for an earlier medullar response. The patient was discharged after 7 days with atenolol 50mg/ day and instructed to have a definite treatment for Graves disease as soon as possible. Conclusion. Such case purpose is to remember clinicians that sepsis diagnosis can be challenged, especially when a thyroid storm is a possible diagnosis as well. In this particular case, both conditions should be treated, but life-threatening sepsis should have the focus for a quick therapeutic approach.

Keywords: Agranulocytosis, Methimazole, Thyroid Crisis, Sepsis, Graves’ disease.

Correspondence: Matheo Augusto Morandi Stumpf MD, Ponta Grossa State University, Medicine, Av. Carlos Cavalcanti, 4748, Ponta Grossa, 84030-900, Brazil, E-mail: matheoaugusto@hotmail.com