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Carbimazole-induced agranulocytosis
Anisha Mohan1, Siby Joseph1, Neeraj Sidharthan2
1Department of Pharmacy Practice, Amrita School of Pharmacy, Kochi, Kerala, India.
Journal of Pharmacology & Pharmacotherapeutics
|January 28, 2016
Summary
Antithyroid medication Carbimazole can cause delayed agranulocytosis, a serious blood disorder. Stopping the drug led to recovery, highlighting the importance of monitoring blood counts.
Area of Science:
- Endocrinology
- Hematology
- Pharmacology
Background:
- A 47-year-old female with a 1.5-year history of hyperthyroidism was treated with Carbimazole.
- She presented with a 3-week history of intermittent fever and severe bifrontal headaches.
Observation:
- Investigations revealed anemia, neutropenia, leucopenia, and elevated C-reactive protein.
- Peripheral smear showed normocytic normochromic anemia with Rouleaux formation and atypical cells.
- Extensive serological testing for infections and autoimmune markers, including Widal, TORCH, ANA, cANCA, and pANCA, were negative.
Findings:
- Bone marrow aspiration indicated normo to hypercellular marrow with 15% atypical cells and plasma cells.
- Despite initial presentation, multiple myeloma workup was negative.
- Carbimazole was discontinued, leading to a normalization of blood parameters.
Implications:
- This case highlights a rare delayed-onset drug-induced agranulocytosis secondary to Carbimazole, presenting 1.5 years after initiation.
- The de-challenge and subsequent recovery of blood parameters underscore the causal link and the importance of vigilant monitoring for hematological adverse effects of antithyroid drugs.
- Physicians should consider delayed agranulocytosis in patients on long-term antithyroid therapy presenting with unexplained fever and cytopenias.
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