Agranulocytosis: A Rare Complication and Management Paradox

Introduction: Thyroid disorders are common disorders seen around the globe. The prevalence of thyroid disorders in India is approximately 5-10%, more common in females and hypothyroidism being more common than hypothyroidism followed by hyperthyroidism. Anti-thyroid drugs are commonly used for the medical management of hyperthyroidism. A rare and notoriously dangerous complication of these drugs is agranulocytosis, seen in 0.3-0.5% of treated patients. Case: A 50 year old female presented in the emergency department with high grade fever associated with rigors and severe throat paint associated with difficult and painful swallowing since 5 days. She was a known case of hyperthyroidism on carbimazole 30 mg once daily since 1 year. Patient was vitally stable and throat examination showed severely enlarged and inflamed tonsils with inflamed posterior pharyngeal. ENT opinion was taken which advised for conservative management and elective tonsillectomy later. The entire fever profile was negative. Her total leucocyte count was 650 cells/mm3. Carbimazole induced agranulocytosis was suspected and the drug was withheld. Gradually the WBC count started to rise and patient recovered symptomatically. Conclusion: Agranulocytosis is a potentially lethal side effect but if diagnosed early is treatable. High index of suspicion and timely drug withdrawal is the key to reduce morbidity and mortality.