Stumpf M A M, Schrut G C A, Ramthun M, Onuma S, Osternack H E C G
Ponta Grossa State University - Medicine, Ponta Grossa, Brazil.
Acta Endocrinol (Buchar). 2019 Oct-Dec;15(4):522-525. doi: 10.4183/aeb.2019.522.
Agranulocytosis induced by thioamides is rare, occurring only in 0.2-0.5% of cases.
We present the case of a 45-year-old woman previously diagnosed with Graves' disease that discontinued the use of methimazole on her own. She attended the Emergency Department presenting fever (40.5¯C), agitation and diaphoresis. A thyroid storm diagnosis was initially thought, but after laboratory results showing neutrophil count near 0.06x109/L, sepsis due to neutropenia seemed the most logical hypothesis. Cephepime was promptly initiated. For thyrotoxicosis management, cholestyramine and atenolol were prescribed. In her second day of hospitalization, subcutaneous granulocyte colony-stimulating factor was started for an earlier medullar response. The patient was discharged after 7 days with atenolol 50mg/day and instructed to have a definite treatment for Graves disease as soon as possible.
Such case purpose is to remember clinicians that sepsis diagnosis can be challenged, especially when a thyroid storm is a possible diagnosis as well. In this particular case, both conditions should be treated, but life-threatening sepsis should have the focus for a quick therapeutic approach.
硫代酰胺引起的粒细胞缺乏症很罕见，仅发生于0.2 - 0.5%的病例中。
我们报告一例45岁女性病例，该患者先前被诊断为格雷夫斯病，自行停用了甲巯咪唑。她因发热（40.5℃）、烦躁和多汗就诊于急诊科。最初考虑诊断为甲状腺危象，但实验室检查结果显示中性粒细胞计数接近0.06×10⁹/L后，因中性粒细胞减少导致的脓毒症似乎是最合理的假设。立即开始使用头孢吡肟治疗。对于甲状腺毒症的处理，给予了考来烯胺和阿替洛尔。住院第二天，开始皮下注射粒细胞集落刺激因子以促进更早的骨髓反应。患者在7天后出院，服用阿替洛尔50mg/天，并被指示尽快对格雷夫斯病进行明确治疗。
该病例旨在提醒临床医生，脓毒症的诊断可能存在挑战，尤其是当甲状腺危象也可能是诊断之一时。在这种特殊情况下，两种情况都应进行治疗，但危及生命的脓毒症应成为快速治疗的重点。
