甲巯咪唑致重度粒细胞缺乏1例

One case of severe agranulocytosis induced by methimazole

1例21岁女性患者,2年前诊断为甲状腺功能亢进症,规律服用甲巯咪唑30 mg·d^(-1)治疗。1年前因发热停用甲巯咪唑,改用丙硫氧嘧啶治疗,因效果不佳,近3周重新应用甲巯咪唑30 mg·d^(-1)治疗。2 d前出现发热、咳嗽等症状,查血常规白细胞明显减少伴中性粒细胞缺乏,最低至白细胞0.3×10~9·L^(-1),中性粒细胞0.04×10~9·L^(-1),伴高热,诊断为"粒细胞缺乏症"。遂停用甲巯咪唑,并给予"重组人粒细胞刺激因子、鲨肝醇、利可君"升高白细胞,同时积极给予抗感染等治疗。治疗9 d后,患者白细胞及中性粒细胞逐渐升至正常范围,病情稳定。

One 21-year-old female patient with a history of hyperthyroidism for 2 years had received methimazole therapy（10 mg thrice daily） for 1 year. One year ago, she stopped methimazole because of fever, and switched to therapy with propylthiouracil. Due to poor treatment effect, she reapplied methimazole therapy（10 mg thrice daily） 3 weeks ago. The patient had a fever and cough 2 days before hospitalization. Blood routine examination showed leucopenia with neutropenia. White blood cell count was 0.3 × 10^9·L^-1, and the absolute neutrophil count was 0.04 × 10^9·L^-1. She had a fever, and was diagnosed with neutropenia. Methimazole was stopped. Recombinant human granulocyte colony-stimulating factor, batyl alcohol and leucogen were provided to elevate white blood cell, and antibiotics were also given. White blood cell count recovered to normal range on the 9^th day. The symptoms also resolved.