Antithyroid Drug-induced Agranulocytosis Complicated by Pneumococcal Sepsis and Upper Airway Obstruction

Naoto Ishimaru; Hisashi Ohnishi; Teruaki Nishiuma; Ryota Doukuni; Kanoko Umezawa; Sachiko Oozone; Emi Kuramoto; Sho Yoshimura; Saori Kinami

doi:10.2169/internalmedicine.52.0220

CASE REPORTS

Antithyroid Drug-induced Agranulocytosis Complicated by Pneumococcal Sepsis and Upper Airway Obstruction

Naoto Ishimaru, Hisashi Ohnishi, Teruaki Nishiuma, Ryota Doukuni, Kanoko Umezawa, Sachiko Oozone, Emi Kuramoto, Sho Yoshimura, Saori Kinami

Author information

Naoto Ishimaru
Department of Respiratory Medicine and Internal Medicine, Akashi Medical Center, Japan
Hisashi Ohnishi
Department of Respiratory Medicine and Internal Medicine, Akashi Medical Center, Japan
Teruaki Nishiuma
Department of Internal Medicine, Kakogawa West City Hospital, Japan
Ryota Doukuni
Department of Respiratory Medicine and Internal Medicine, Akashi Medical Center, Japan
Kanoko Umezawa
Department of Respiratory Medicine and Internal Medicine, Akashi Medical Center, Japan
Sachiko Oozone
Department of Respiratory Medicine and Internal Medicine, Akashi Medical Center, Japan
Emi Kuramoto
Department of Respiratory Medicine and Internal Medicine, Akashi Medical Center, Japan
Sho Yoshimura
Department of Respiratory Medicine and Internal Medicine, Akashi Medical Center, Japan
Saori Kinami
Department of Respiratory Medicine and Internal Medicine, Akashi Medical Center, Japan

Keywords: antithyroid agents, agranulocytosis, pneumococcal infection, airway obstruction, granulocyte colony-stimulating factor

JOURNAL OPEN ACCESS

2013 Volume 52 Issue 20 Pages 2355-2359

DOI https://doi.org/10.2169/internalmedicine.52.0220

Details

Abstract

Streptococcus pneumoniae is a rare pathogen of sepsis in patients with antithyroid drug-induced agranulocytosis. We herein describe a case of antithyroid drug-induced agranulocytosis complicated by pneumococcal sepsis and upper airway obstruction. A 27-year-old woman who was previously prescribed methimazole for nine months presented with a four-day history of a sore throat. She nearly choked and was diagnosed with febrile agranulocytosis. She was successfully treated with intubation, intravenous antibiotics and granulocyte colony-stimulating factor. Her blood cultures yielded S. pneumoniae. Emergency airway management, treatment of sepsis and the administration of granulocyte colony-stimulating factor can improve the clinical course of antithyroid drug-induced pneumococcal sepsis in patients with airway obstruction.

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