Korean J Med.  2014 Feb;86(2):232-236.

A Case of Acute Appendicitis in a Patient with Methimazole-Induced Agranulocytosis

• Hong AR
• Park KS
• Jo YS
• Park DJ
• Park YJ
• Kim JH

Abstract

Agranulocytosis is a rare, but life-threatening, adverse effect of methimazole, which usually manifests as an upper respiratory infection. Agranulocytosis together with acute appendicitis is especially rare in patients with Graves' disease taking methimazole. A 44-year-old woman presented to our hospital with abdominal pain and a fever. She had been taking methimazole and propranolol for Graves' disease for the previous 8 weeks. Her symptoms were compatible with acute appendicitis. Computed tomography of the abdomen revealed acute appendicitis with impending rupture. However, the circulating absolute neutrophil count was 10/mm3. We managed her with antibiotics and granulocyte colony stimulating factor rather than with emergency surgery. The thyrotoxicosis was treated with intravenous contrast medium while fasting, followed by Lugol's solution and lithium. After recovering from the neutropenia, she underwent a total thyroidectomy combined with an appendectomy. Here, we report a patient with Graves' disease who developed methimazole-induced agranulocytosis presenting as acute appendicitis.

Keyword

Graves' disease; Agranulocytosis; Acute appendicitis

MeSH Terms

Abdomen
Abdominal Pain
Adult
Agranulocytosis*
Anti-Bacterial Agents
Appendectomy
Appendicitis*
Colony-Stimulating Factors
Emergencies
Fasting
Female
Fever
Granulocytes
Graves Disease
Humans
Lithium
Methimazole
Neutropenia
Neutrophils
Propranolol
Rupture
Thyroidectomy
Thyrotoxicosis
Anti-Bacterial Agents
Colony-Stimulating Factors
Lithium
Methimazole
Propranolol