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CASE REPORT
Year : 2009  |  Volume : 6  |  Issue : 3  |  Page : 84-87

Granulocyte colony stimulating factor in the treatment anti-thyroid drug induced agranulocytosis


1 Department of Endocrinology, Andhra Medical College, Visakhapatnam-17, India
2 Department of Neurology, Andhra Medical College, Visakhapatnam-17, India

Correspondence Address:
M P Baruah
Department of Endocrinology, Andhra Medical College, Visakhapatnam-17
India
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Source of Support: None, Conflict of Interest: None


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Aim: To report a case with life threatening agranulocytosis induced by anti thyroid drug Carbimazole, which was treated with granulocyte colony stimulating factor (G-CSF) with favorable outcome. Methods: We present the clinical features, laboratory findings, clinical course, relevant monitoring records and outcome of the study patient. Results: A 40 year old lady presented with clinical and biochemical evidence of thyrotoxicosis due to Graves ' disease for eight months. She was being treated with Carbimazole when she started having fever, painful oral ulcers, severe weakness and progressive anemia and agranulocytosis {Absolute Neutrophil Count (ANC) <150cells/ /uL(0.15X10 9 cells/ L)}. There was evidence of ongoing severe sepsis like high fever and elevated serum C-reactive protein. Recombinant-human G-CSF was started at this point and we continued to assess the leukocyte and neutrophil count daily. Both these counts rose insidiously during first 96 hours; however significant response was seen on 5th day after 4 injections with Total Leukocyte Count (TLC) reaching 3,400cells/ /uL (3.4X1 (f cells/L) and ANC 1870cells/juL (1.87 X10 9 cells/L). The counts continued to rise from this point onwards even without G-CSF injections, accompanied by improvement in her general condition. Conclusion: The clinical setting in this patient was suitable for G-CSF treatment. Such a decision was well vindicated by profound leukocytosis and early recovery from clinical symptoms. The shortened window can significantly reduce the risk of potentially fatal outcome.


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