Yamamoto Akemi, Katayama Yasuyuki, Tomiyama Koji, Hosoai Hiroshi, Hirata Fumihiko, Kimura Fumihiko, Fujita Kazuyuki, Yasuda Hiroko
Internal Medicine, The Japan Self-Defense Forces Central Hospital, Tokyo, Japan.
Thyroid. 2004 Mar;14(3):231-5. doi: 10.1089/105072504773297911.
Aplastic anemia is a rare but severe complication of methimazole (MMI) treatment for Graves' disease. We present a case of a 53-year-old Japanese female who had been treated with 30 mg/d of MMI for 30 days for Graves' disease and was subsequently admitted to the Japan Self Defense Forces (JSDF) Central Hospital with a mild sore throat and high-grade fever that began the previous day. The patient had a reduced white blood cell count (WBC) count of 0.9 x 10(3) per microliter with severe granulocytopenia and increased lymphocytes, a platelet count of 49 x 10(3) per microliter, and hemoglobin of 10.6 g/dL. Bone marrow (BM) aspirates showed hypocellular bone marrow with plasmacytosis. Because of poor recovery of her peripheral blood values after withdrawal of MMI, she was given transfusions of platelets and erythrocytes thereafter. This is the second report of plasmacytosis in bone marrow of MMI-induced aplastic anemia, and suggests that immunogenic mechanisms may cause this rare complication.
再生障碍性贫血是格雷夫斯病（Graves' disease）患者接受甲巯咪唑（MMI）治疗时罕见但严重的并发症。我们报告一例53岁日本女性，她因格雷夫斯病接受了30天每天30毫克甲巯咪唑的治疗，随后因前一天开始出现的轻度咽痛和高热入住日本自卫队中央医院。患者白细胞计数（WBC）降至每微升0.9×10³，伴有严重粒细胞减少和淋巴细胞增多，血小板计数为每微升49×10³，血红蛋白为10.6克/分升。骨髓穿刺显示骨髓细胞减少伴浆细胞增多。由于停用甲巯咪唑后外周血值恢复不佳，此后她接受了血小板和红细胞输注。这是关于甲巯咪唑诱导的再生障碍性贫血骨髓中浆细胞增多的第二篇报道，并提示免疫原性机制可能导致这种罕见并发症。
