Recombinant Human Granulocyte Colony-Stimulating Factor in Treatment of Methimazole-Induced Agranulocytosis

Abstract

Recently, a patient was encountered in whom agranulocytosis developed shortly after methimazole treatment was initiated because of Graves’ disease. The favorable experience with G-CSF in treating this patient is described herein. Objective To describe a patient with methimazoleinduced agranulocytosis who was treated with recombinant human granulocyte colony-stimulating factor (G-CSF). Methods 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. Results 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. Antman K.S. Griffin J.D. Elias A. et al. Effect of recombinant human granulocyte-macrophage colony-stimulating factor on chemotherapy-induced myelosuppression. N Engl J Med. 1988; 319: 593-598 Crossref PubMed Scopus (550) Google Scholar /L on the 9th hospital day and was more than 1.5 × 10 9. Antman K.S. Griffin J.D. Elias A. et al. Effect of recombinant human granulocyte-macrophage colony-stimulating factor on chemotherapy-induced myelosuppression. N Engl J Med. 1988; 319: 593-598 Crossref PubMed Scopus (550) Google Scholar /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. Conclusion 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. (Endocr Pract. 1997; 3:240-242)