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  • Title: Methimazole-Induced Aplastic Anemia with Concomitant Hepatitis in a Young Filipina with Graves' Disease.
    Author: Wijaya N, Ong-Ramos C.
    Journal: J ASEAN Fed Endocr Soc; 2019; 34(1):99-102. PubMed ID: 33442144.
    Abstract:
    A 34-year-old female Filipino with Graves' disease on methimazole came in due to fever, sore throat and jaundice. She was initially diagnosed with methimazole-induced agranulocytosis and drug-induced liver injury. She was treated with intravenous broad-spectrum antibiotic and granulocyte colony stimulating factor. On day 4 of admission, she developed pancytopenia and was managed as methimazole-induced aplastic anemia. She was started on steroid therapy and received 1 unit of packed red blood cell. The jaundice also increased, hence, she was given ursodeoxycholic acid. On day 9 of admission, with the consideration of "lineage steal phenomenon," biopsy was done and eltrombopag was started. Patient was discharged stable at 12th hospital day. This case presents 3 rare life-threatening complications of methimazole namely: agranulocytosis, aplastic anemia and hepatitis.
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