title: Methimazole Induced Total Myeloid Aplasia with Delayed Recovery Despite Granulocyte Colony Stimulating Factor (G-CSF): Marrow Progenitor Recovery Kinetics.
abstract: An eighteen-year-old female with Graves thyrotoxicosis presented with methimazole-induced agranulocytosis and total myeloid aplasia. The bone marrow at presentation showed complete absence of myeloid precursors and striking plasmacytosis. 16 days later, myeloid precursors were still absent morphologically; however bone marrow flow cytometry and cell culture detected an improvement in myelogenesis, which was soon followed by clinical recovery of agranulocytosis. Neutrophil recovery was delayed until day 22 after cessation of methimazole despite G-CSF use, consistent with a direct toxic effect on committed myeloid cells. Our findings suggest that cell culture and flow cytometric evaluation of bone marrow myeloid progenitors can be used as a guide to anticipate neutrophil recovery.
authors.affiliation: Division of Hematology/Oncology, Carman Ann Adams Children's Hospital of Michigan, Wayne State University, 3901 Beaubien Blvd., Detroit, MI 48201 USA.
authors.forename: Tania
authors.initials: T
authors.lastname: Sarker
authors.affiliation: Division of Hematology/Oncology, Carman Ann Adams Children's Hospital of Michigan, Wayne State University, 3901 Beaubien Blvd., Detroit, MI 48201 USA.
authors.forename: Bülent
authors.initials: B
authors.lastname: Özgönenel
authors.affiliation: Division of Hematology/Oncology, Carman Ann Adams Children's Hospital of Michigan, Wayne State University, 3901 Beaubien Blvd., Detroit, MI 48201 USA.
authors.forename: Manisha
authors.initials: M
authors.lastname: Gadgeel
authors.affiliation: Division of Hematology/Oncology, Carman Ann Adams Children's Hospital of Michigan, Wayne State University, 3901 Beaubien Blvd., Detroit, MI 48201 USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Buck
authors.affiliation: Division of Endocrinology, Carman Ann Adams Children's Hospital of Michigan, Wayne State University, Detroit, MI USA.
authors.forename: Amita
authors.initials: A
authors.lastname: Adhikari
authors.affiliation: Division of Hematology/Oncology, Carman Ann Adams Children's Hospital of Michigan, Wayne State University, 3901 Beaubien Blvd., Detroit, MI 48201 USA.
authors.forename: Yaddanapudi
authors.initials: Y
authors.lastname: Ravindranath
keywords: Bone marrow cell culture; Flow cytometry; G-CSF; Methimazole; Total myeloid aplasia