A case of antithyroid drug-induced agranulocytosis complicated by acute epiglottitis and deep neck abscesses leading to airway management and external neck drainage

Abstract

Agranulocytosis is a serious side effect of antithyroid drugs. We report a case of antithyroid drug-induced agranulocytosis complicated by acute epiglottitis and deep neck abscesses. A 43-year-old woman was prescribed thiamazole for Graves' disease. She visited her regular doctor because of sore throat and high fever. She was diagnosed with agranulocytosis and was admitted to our hospital. We checked her throat because she had severe throat pain: she nearly choked due to acute epiglottitis. We intubated her using a flexible video laryngoscope. After noting a high neutrophil count, bilateral deep neck abscesses were detected. The abscesses were treated by neck incision and drainage. Intubation using an endoscope appears to be effective for a patient who should avoid surgery. The timing of abscess formation was different from usual in a patient with agranulocytosis. She suffered pulmonary embolism during the progress of treatment. A total thyroidectomy was performed for Graves' disease.