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메티마졸에 의한 무과립구증 상태에서 급성 충수돌기염이 발생한 그레이브스병 환자

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Journal Title
Keimyung Medical Journal
Issued Date
2015
Keyword
Graves' disease
Abstract
Methimazole-induced agranulocytosis is a rare but critical side effect which may cause a life-threatening state during Graves’ disease treatment. In management of methimazole-induced agranulocytosis, the most important thing is withdrawal of ATD (anti-thyroid drug) and empirical broad spectrum antibiotics can be used. Also, G-CSF or GM-CSF is generally recommended as it could be helpful in restoration of neutropenia. Pathophysiology of appendicitis is obstruction of the lumen of the appendix caused by infection or hyperplasia of submucosal follicles. Recently, management of appendicitis has been reported to be successful with conservative antibiotics administration without appendectomy. A 27-year-old man visited our hospital experiencing febrile sensation, painful throat, and abdominal pain. The patient had been diagnosed with Graves’ disease 1 month previously and had taken methimazole 10 mg daily (tapered dose from initial 30 mg daily). Agranulocytosis was confirmed with neutrophils count and peripheral blood smear, and the finding of ultrasonography and abdominal CT scan were compatible with acute appendicitis. We report a rare case of methimzole-induced agranulocytosis combined with acute appendicitis in the course of Graves’ disease treatment. In this
case, withdrawal of ATD (anti-thyroid drug) caused thyroid storm and appendectomy was not performed due to operative risk. Thyroid storm was treated with radioiodine ablation, and appendicitis was treated with antibiotics without appendectomy. With the use of G-CSF and conservative management, improvement of not only the clinical manifestation
but also agranulocytosis was seen.
Alternative Title
(A)patient of graves' disease with methimazole induced agranulocytosis combined with acute appendicitis
Publisher
Keimyung University School of Medicine
Citation
이자연 et al. (2015). 메티마졸에 의한 무과립구증 상태에서 급성 충수돌기염이 발생한 그레이브스병 환자. Keimyung Medical Journal, 34(1), 64–69.
Type
Article
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/15663
Appears in Collections:
2. Keimyung Medical Journal (계명의대 학술지) > 2015
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