Recombinant human granulocyte colony-stimulating factor in treatment of methimazole-induced agranulocytosis

To describe a patient with methimazole-induced agranulocytosis who was treated with recombinant human granulocyte colony-stimulating factor (G-CSF).

A case report is presented, in which the clinical and laboratory findings are detailed and the response to treatment is discussed. Pertinent reports from the literature are reviewed.

In a 24-year-old woman with Graves' disease who was treated with methimazole, a fever and sore throat developed; bone marrow examination revealed absence of granulocytes. After discontinuation of methimazole therapy, treatment with G-CSF was implemented in an attempt to hasten the reappearance of the granulocytes. The patient's granulocyte count reached 0.5 10(9)/L on the 9th hospital day and was more than 1.5 10(9)/L on the 10th day. Because the recovery time for thionamide-induced agranulocytosis typically ranges from 1 to 2 weeks and sometimes is even longer, G-CSF may have been beneficial in accelerating the return of the granulocytes.

Only a small number of patients with thionamide-induced agranulocytosis have had G-CSF treatment, and most outcomes have generally supported a beneficial effect. More experience is needed with the use of G-CSF in such circumstances. Nevertheless, its use seems to be a reasonable therapeutic option for consideration in patients with thionamide-induced agranulocytosis.