Carbimazole induced agranulocytosis with life-threatening complications, tremendous response with granulocyte-colony stimulating factor

Abstract

Agranulocytosis is a rare complication of drug carbimazole (0.23%). We are accounting to present a very interesting and rare case of agranulocytosis and neutropenic sepsis secondary to carbimazole that have tremendous response with recombinant human granulocyte colony-stimulating factor (G-CSF). A 35-year-old woman with hyperthyroidism since 1-month, who developed delayed carbimazole induced agranulocytosis. She presented with a fever, cough, sore throat and painful mouth ulcer since 7day. Investigations revealed hyperthyroidism with neutropenia, white blood cell of 0.3 × 10 9(neutrophils of 0.0 × 10 9/L). Bone marrow aspiration revealed a hypocellular marrow with reduced myelopoiesis with minimal maturation, consistent with drug-induced neutropenia. G-CSF was used as an adjunctive therapy with discontinuation of carbimazole, barrier nursing and a broad-spectrum antibiotic (Third-generation cephalosporins) regimen to treat her neutropenic sepsis. Total white cell count and neutrophil count returned to normal on 5 days treatment and she made an uneventful recovery. She was subsequently rendered euthyroid with radioiodine treatment.