Tavintharan S, Rajasoorya C, Chew L S
Department of Medicine, Alexandra Hospital, Singapore.
Singapore Med J. 1997 Sep;38(9):386-7.
Carbimazole is a useful antithyroid drug with a rare potentially fatal complication of agranulocytosis. We report 2 cases presenting with this problem. One was treated supportively with barrier nursing and broad spectrum antibiotics, and the other needed use of a haemopoietic growth factor, granulocyte colony stimulating factor (G-CSF). As it is indeed possible for thyrotoxic patients who developed agranulocytosis with carbimazole to have the same complication with propylthiouracil, once agranulocytosis had resolved, both patients were treated with radioiodine to maintain euthyroidism. Carbimazole-induced agranulocytosis usually spontaneously resolves within 1 to 2 weeks of stopping the drug. The use of haemopoietic growth factors to stimulate the proliferation and differentiation of progenitor cells, accelerates neutrophil recovery, as in our first case discussed. We recognise that agranulocytosis from carbimazole is a rare, life-threatening complication. Instead of awaiting spontaneous recovery, the use of haemopoietic growth factors certainly seems a justifiable option, with a promise of a reduction in morbidity and mortality.
卡比马唑是一种有效的抗甲状腺药物，可引发罕见的、有潜在致命风险的粒细胞缺乏症。我们报告2例出现该问题的病例。1例采用保护性隔离护理及广谱抗生素进行支持治疗，另1例则需要使用造血生长因子——粒细胞集落刺激因子（G-CSF）。鉴于服用卡比马唑发生粒细胞缺乏症的甲状腺毒症患者确实有可能在使用丙硫氧嘧啶时出现同样的并发症，在粒细胞缺乏症症状消除后，2例患者均接受放射性碘治疗以维持甲状腺功能正常。卡比马唑所致的粒细胞缺乏症通常在停药后1至2周内自行缓解。如我们所讨论的首例病例那样，使用造血生长因子刺激祖细胞的增殖和分化，可加速中性粒细胞的恢复。我们认识到，卡比马唑引起的粒细胞缺乏症是一种罕见的、危及生命的并发症。与其等待自行恢复，使用造血生长因子显然是一个合理的选择，有望降低发病率和死亡率。
