J Korean Endocr Soc.  2008 Dec;23(6):420-424. 10.3803/jkes.2008.23.6.420.

A Case of Methimazole-induced Agranulocytosis and Kikuchi's Disease in a Patient with Graves' Disease

Affiliations
  • 1Division of Endocrinology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.

Abstract

Methimazole-induced agranulocytosis is a rare, but critical side effect that should be recognized as soon as possible since it may induce a life-threatening condition when it was overlooked. Histiocytic necrotizing lymphadenitis is also called Kikuchi's lymphadenitis, and this is a rare form of lymphadenitis with a self-limited clinical course and this illness is accompanied by cervical lymph node enlargement, fever and malaise. We recently experienced a patient with methimazole-induced agranulocytosis and Graves' disease, and this was accompanied by Kikuchi's disease; the patient presented with sore throat and multiple enlarged cervical lymph nodes. To the best of our knowledge, there is no previous report on methimazole-induced agranulocytosis combined with Kikuchi's disease. Therefore, we report here on this very rare case along with a brief review of the relevant literature.

Keyword

agranulocytosis; Graves' disease; Kikuchi's disease

MeSH Terms

Agranulocytosis
Fever
Graves Disease
Histiocytic Necrotizing Lymphadenitis
Humans
Lymph Nodes
Lymphadenitis
Pharyngitis

Figure

  • Fig. 1 Neck CT shows multiple enlarged lymph nodes in bilateral submandibular spaces and bilateral internal jugular chain (arrows).

  • Fig. 2 Chest X-ray (A) and CT (B) show multiple nodular lesions on the both lung field (arrow).

  • Fig. 3 Lymphoid cells, histiocyte and karyorrhectic nuclei are noted in the necrotic background (PAP staining, ×400).


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