Objective:To discuss the clinical manifestations and laboratory examination results of agranulocytosis and reactive plasmacytosis(RP)in the patient with Graves'disease(GD)after treated with methimazole(MMI),and to provide the basis for the clinicians to differentiate RP from multiple myeloma(MM).Methods:The clinical manifestations,laboratory examinations,diagnosis and treatment processes of one patient with GD agranulocytosis complicated with RP were analyzed,and the related literatures were reviewed.Results:The patient had a history of GD and abdominal infection.Upon admission,a complete blood count revealed a significant decrease in white blood cell count accompanied by neutropenia,and a smear re-examination showed suspicious plasma cells.The bone marrow cytology examination results showed the percentage of bone marrow plasma cells was 33％,and the percentage of plasma cells in peripheral blood was 4％;the serum immunoglobulin results showed polyclonal hyperplasia;the serum immunofixation electrophoresis results were negative;the flow cytometry analysis results indicated the immunophenotype of the plasma cells was normal.Based on the medical history and laboratory results,MM was largely excluded,supporting the diagnosis of RP.Neutropenia was considered to be related to medication,so MMI was discontinued,granulocyte colony-stimulating factor was administered to increase the number of white blood cells,and specialized GD treatment was conducted after controlling the abdominal infection.The patient had a good prognosis,and his blood count was normal upon re-examination 6 months later.Conclusion:Agranulocytosis complicated with RP in the GD patients is clinically rare.Serum immunofixation electrophoresis,blood cell morphology,and cell immunophenotype analysis are helpful for the accurate diagnosis.After actively treating the primary disease causing RP,the patient's prognosis is favorable.

Objective To investigate the effect of the levels of interleukin-2R(IL-2R),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)on the clinical prognosis of patients with acute ischemic stroke(AIS)undergoing me-chanical thrombolysis.Methods A retrospective analysis was performed for 156 AIS patients who underwent mechanical thrombectomy,and related clinical data and laboratory markers of inflammatory factors(IL-2R,IL-6,and TNF-α)were collected.On day 90 after mechanical thrombectomy,the patients were divided into good prognosis group and poor progno-sis group based on modified Rankin Scale(mRS).Univariate and multivariate logistic regression analyses were used to in-vestigate the association between the levels of inflammatory factors and poor prognosis on day 90 after surgery,and the re-ceiver operating characteristic(ROC)curve was plotted to investigate the efficacy of inflammatory factors in predicting poor prognosis.Results The incidence rate of poor prognosis was 67.9%on day 90 after surgery,and after adjustment for confounding factors,the multivariate logistic regression analysis showed that high IL-2R level,high platelet count,bridging therapy,and recanalization with one pull of the bolus were protective factors for the prognosis of AIS patients on day 90 after mechanical thrombolysis[odds ratio(OR)<1,P<0.05],and fasting blood glucose and NIHSS score after thrombectomy were risk factors for poor prognosis on day 90 after mechanical thrombolysis in patients with AIS(OR>1,P<0.05);IL-6 and TNF-α were not independent influencing factors for poor prognosis in patients with AIS on day 90 after mechanical thrombolysis(P>0.05).The ROC curve showed that IL-2R or NIHSS score after thrombectomy used alone or in combination had an area under the ROC curve of 0.801,0.804,and 0.892,respectively,in predicting poor prognosis on day 90 after surgery,and the combination of IL-2R and NIHSS score after thrombectomy had a higher predictive value.Conclusion The high level of IL-2R is independently associated with a good prognosis in AIS patients on day 90 after mechanical thrombolysis,and NIHSS score after thrombectomy combined with IL-2R has better predictive efficacy than NIHSS score after thrombectomy alone.For the time being,no independent effect of IL-6 and TNF-α has been found on the poor prognosis of AIS patients on day 90 after mechanical thrombolysis.