초록
무과립구증은 메티마졸을 복용하는 환자에서 드물게 발생하나 치명적인 부작용으로서 대부분 상기도 감염의 형태로 발현한다. 그레이브스병으로 메티마졸을 복용하던 환자에서 무과립구증이 급성충수염으로 발현한 증례는 보고된바 없다. 본 저자들은 그레이브스병으로 메티마졸을 복용하던 중 발생한 무과립구증이 드물게 급성충수염으로 발현한 환자에서 적절한 내과적 치료 및 수술적 치료 후 양호한 경과를 확인하였기에 문헌고찰과 함께 보고하는 바이다.
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 $10/mm^3$. 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.
