Abstract
We report a 17-year-old female patient who developed a severe agranulocytosis at 12 months of treatment with methimazole (MMI) for hyperthyroidism. White blood cell (WBC) count was 1200/μL with 48/μL of granulocytes at the onset of a high fever and sore throat due to necrotizing laryngitis and ulcerative pharyngitis. Granulocyte colony-stimulating factor (G-CSF) was administered intravenously on a daily basis at a dosage of 50μg/M2 of body surface for 9 days. The count of WBC and granulocytes revealed a rapid increase followed by an improvement in the clinical symptoms. As a decrease of granulocytes was seen after ceasing G-CSF, additional G-CSF therapy was carried out for 11 days. Total thyroidectomy was performed on the 5th day of the second G-CSF therapy. The patient has been doing well and is euthyroid after replacement therapy with thyroxine. In this case, G-CSF was found to be a potent agent for the management of MMI-induced agranulocytosis.
