Carbimazole-related agranulocytosis in pregnancy - A case report
- Author:
Lim SS
;
Shireene V
;
Vijay A
;
Tan TBA
;
Rokiah P
;
Chan SP
- Publication Type:Journal Article
- Keywords:
Thyrotoxicosis, carbimazole, agranulocytosis, neutropaenia, pregnancy, granulocyte colony stimulating factor
- From:Journal of University of Malaya Medical Centre
2007;10(1):34-38
- CountryMalaysia
- Language:English
-
Abstract:
We report a 33-year-old Malay lady who presented with fever, tonsillitis and pharyngitis
a month after initiation of antithyroid therapy (carbimazole 15 mg tds) for thyrotoxicosis by her general
practitioner. She was still clinically and biochemically thyrotoxic but not in thyroid storm. At that
time, she was also confirmed to be four weeks pregnant. Her full blood count revealed neutropaenia
with an absolute neutrophil count of 0.036 × 109/L. Bone marrow aspirate and trephine were compatible
with carbimazole-related agranulocytosis. Carbimazole was discontinued and she was given broad
spectrum antibiotics and Granulocyte Colony Stimulating Factor (GCSF), to which she responded.
Verapamil was used for symptomatic heart rate control instead of beta-blockers as she had a history of
bronchial asthma. The patient subsequently opted for termination of pregnancy after which she was
given radioactive iodine I131 (10 mCi) for definitive therapy of her thyrotoxicosis. In conclusion,
carbimazole-related agranulocytosis is an important entity to recognise and treat early to prevent
morbidity and mortality. Termination of pregnancy was carried out as the treatment given during the
episode of agranulocytosis may have negative effects on foetal viability and growth.
