Introduction: Autoimmune thyroid disease is frequently associated with other immune-mediated disorders; however, clinically significant pancytopenia is rare. In patients with Graves’ disease receiving antithyroid therapy, leukopenia raises concern for drug-induced agranulocytosis, a rare but potentially life-threatening complication characterized by severe neutropenia requiring immediate drug withdrawal. The coexistence of hemolytic anemia and thrombocytopenia may instead suggest Evans syndrome, defined by autoimmune hemolytic anemia with immune thrombocytopenia, with or without neutropenia. Importantly, uncontrolled thyrotoxicosis itself may cause immunemediated cytopenias, creating a diagnostic challenge. Case: We report a 55-year-old female with thyroid receptor antibody-positive Graves’ disease who presented with jaundice and pancytopenia while receiving carbimazole therapy. Laboratory evaluation demonstrated anemia with reticulocytosis and a positive direct antiglobulin test, thrombocytopenia and leukopenia. Complement testing revealed reduced C3 with normal C4, consistent with immune-mediated hemolysis. Peripheral blood film showed no blast cells or marrow infiltration, and autoimmune screening, including antinuclear antibodies and anti–double stranded DNA, was negative. The coexistence of Coombs-positive hemolysis and thrombocytopenia initially raised suspicion for Evans syndrome, while leukopenia during carbimazole therapy prompted concern for drug-induced agranulocytosis. However, neutropenia was not severe, and the absence of marrow infiltration or systemic autoimmune disease made alternative causes of pancytopenia less likely. Importantly, blood counts progressively improved following the optimization of thyroid control despite continuation of carbimazole at a reduced dose, without the use of immunosuppressive therapy. This clinical course supported the interpretation of thyrotoxicosis-associated immune cytopenia rather than primary Evans syndrome or carbimazole-induced agranulocytosis. Conclusion This case highlights thyrotoxicosis-associated immune cytopenia as an important mimic of Evans syndrome and carbimazole-related hematological toxicity. Recognizing this entity is essential to avoid unnecessary discontinuation of antithyroid therapy or inappropriate immunosuppressive treatment.
Evans Syndrome ; Carbimazole ; Pancytopenia ; Agranulocytosis ; Graves Disease

In the twenty-first century, high contagious infectious diseases such as SARS (Severe Acute Respiratory Syndrome), MERS (Middle East Respiratory Syndrome), FMD (Foot-and-Mouth Disease) and AI (Avian Influenza) have become very prevalent, causing treat harm to humans and animals in aspect of public health, and economical issues. The critical problem is that newly-reported infectious diseases that humans firstly experience are expected to continue to emerge, and these diseases will be spreading out rapidly. Therefore, rapid and safe supplies of effective vaccines are most pivotal to prevent the rapid prevalent of new infection, but international standards or assessing protocol the safety of urgent vaccines are not established well. In our previous study, since we established a module to assess the brain safety of urgent vaccines, therefore, it is necessary to verify that this established module for assessing brain safety could work effectively in commercially available two vaccines (one killed- and on live-vaccines). We compared the results of Evans blue (EB) assay and qPCR analysis by injection of two kinds of vaccines, PBS and Lipopolysaccharide (LPS) under the condition of the module previously reported. We confirmed that the brain safety test module for urgent vaccine we established is very reproducible. Therefore, it is believed that this vaccine safety testing method can be used to validate brain safety when prompt supply of a newly developed vaccines is needed.
Animals ; Brain ; Communicable Diseases ; Coronavirus Infections ; Equipment and Supplies ; Evans Blue ; Humans ; Methods ; Public Health ; Severe Acute Respiratory Syndrome ; Vaccines

The case of a pregnant woman initially presenting with low platelets and low haemoglobin and subsequently diagnosed as a case of Evans Syndrome is presented. Owing to its extremely low incidence, little research exists investigating pregnancies complicated by Evans Syndrome. Although diagnosis is simple and straightforward, management of a pregnancy of this nature has proven to be complex and challenging. Further complicating the case and its management is the concurrent diagnosis of Chronic Hypertension with Superimposed Pre-eclampsia, in complete HELLP Syndrome. Pre-eclampsia in the background of Evans Syndrome makes this case a truly interesting case. The individual effects of the two disease entities in a single patient are discussed in this report.

Human ; Female ; Adult ; Pregnancy ; Hellp Syndrome ; Pre-eclampsia ; Evans Syndrome ; Thrombocytopenia ; Anemia, Hemolytic, Autoimmune ; Blood Platelet Disorders ; Hematologic Diseases ; Hypertension

The case of a pregnant woman initially presenting with low platelets and low haemoglobin and subsequently diagnosed as a case of Evans Syndrome is presented. Owing to its extremely low incidence, little research exists investigating pregnancies complicated by Evans Syndrome. Although diagnosis is simple and straightforward, management of a pregnancy of this nature has proven to be complex and challenging. Further complicating the case and its management is the concurrent diagnosis of Chronic Hypertension with Superimposed Pre-eclampsia, in complete HELLP Syndrome. Pre-eclampsia in the background of Evans Syndrome makes this case a truly interesting case. The individual effects of the two disease entities in a single patient are discussed in this report.

Human ; Female ; Adult ; Pregnancy ; Hellp Syndrome ; Pre-eclampsia ; Evans Syndrome ; Thrombocytopenia ; Anemia, Hemolytic, Autoimmune ; Blood Platelet Disorders ; Hematologic Diseases ; Hypertension