Methimazole-induced aplastic anemia caused by hypocellular bone marrow with plasmacytosis.
Aplastic anemia is a rare but severe complication of methimazole (MMI) treatment for Graves' disease. We present a case of a 53-year-old Japanese female who had been treated with 30 mg/d of MMI for 30 days for Graves' disease and was subsequently admitted to the Japan Self Defense Forces (JSDF) Central Hospital with a mild sore throat and high-grade fever that began the previous day. The patient had a reduced white blood cell count (WBC) count of 0.9 x 10(3) per microliter with severe granulocytopenia and increased lymphocytes, a platelet count of 49 x 10(3) per microliter, and hemoglobin of 10.6 g/dL. Bone marrow (BM) aspirates showed hypocellular bone marrow with plasmacytosis. Because of poor recovery of her peripheral blood values after withdrawal of MMI, she was given transfusions of platelets and erythrocytes thereafter. This is the second report of plasmacytosis in bone marrow of MMI-induced aplastic anemia, and suggests that immunogenic mechanisms may cause this rare complication.
Yamamoto
Akemi
A
Internal Medicine, The Japan Self-Defense Forces Central Hospital, Tokyo, Japan. User931115@aol.com
Katayama
Yasuyuki
Y
Tomiyama
Koji
K
Hosoai
Hiroshi
H
Hirata
Fumihiko
F
Kimura
Fumihiko
F
Fujita
Kazuyuki
K
Yasuda
Hiroko
H
D000741:Anemia, Aplastic / Q000139:chemically induced* / Q000473:pathology* / Q000628:therapy; D013956:Antithyroid Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001853:Bone Marrow / Q000187:drug effects* / Q000473:pathology*; D004334:Drug Administration Schedule; D017707:Erythrocyte Transfusion; D005260:Female; D006111:Graves Disease / Q000188:drug therapy; D006801:Humans; D008713:Methimazole / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D010950:Plasma Cells / Q000473:pathology*; D017713:Platelet Transfusion
D013956:Antithyroid Agents; D008713:Methimazole