KMID : 0882420140860020232
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Korean Journal of Medicine 2014 Volume.86 No. 2 p.232 ~ p.236
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A Case of Acute Appendicitis in a Patient with Methimazole-Induced Agranulocytosis
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Hong A-Ram
Park Kyung-Seon Jo Yong-Suk Park Do-Joon Park Young-Joo Kim Jung-Hee
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Abstract
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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.
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KEYWORD
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Graves¡¯ disease, Agranulocytosis, Acute appendicitis
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