Delayed Administration of Granulocyte Colony-Stimulating Factor in the Management of Symptomatic and Severe Propylthiouracil-lnduced Agranulocytosis: A Case Report

摘要

In patients with antithyroid drug-induced agranulocytosis, prompt administration of granulocyte colony-stimulating factor (G-CSF) has been observed in individual cases. In the only prospective study performed, it was concluded that prolonged use of G-CSF at 100 mug/d to 200 mug/d is not beneficial for such patients. Additionally, G-CSF (75 mug/d) was found ineffective in management of antithyroid drug-induced agranulocytosis in symptomatic patients when granulocyte counts fell below 0.1 X 10~9/mL. This report describes a case of propylthiouracil-induced agranulocytosis in a symptomatic subject with a neutrophil count of zero at admission. After 9 days of antibiotic therapy, the subject remained febrile with a neutrophil count of zero. The patient recovered upon treatment with G-CSF at 300 mug/d. This case serves to highlight that, although early administration of G-CSF to patients at risk is desirable, G-CSF at adequate dosage may be beneficial even in symptomatic patients with prolonged and severe agranulocytosis.