甲巯咪唑治疗不当引起再生障碍性贫血和甲状腺危象导致死亡

1例40岁女性甲状腺功能亢进患者，口服甲巯咪唑10mg，3次／d。1个多月后出现高热、肛周疼痛，查白细胞减少，立刻停用甲巯咪唑，用甲硝唑、头孢呋辛抗感染，症状未缓解，并出现心悸、胸闷、食欲不振、少尿，5d后入院。查T40℃，P140/min，R30次／min，BP60／30mmHg。四吱可见散在瘀斑，肛周可见一1．5cm×1．5cm溃疡，有脓性分泌物。WBC0．4×10^9／L，N0．16，Hb94g/L，PLT 11×10^9／L。骨髓检查：增生减低，粒细胞与幼红细胞比值（M：E）=0．5：1，粒、红细胞两系罕见，巨核细胞未见，血小板少见，淋巴细胞0．51，浆细胞0．13，网状细胞0．345。血K^＋2．9mmol／L，Na^＋134mmol／L，Ca^2＋1．6mmol／L，AST53U／L ,ALT 207U／L，白蛋白20g／L，总蛋白48g／L。甲状腺功能检查：FT3 38．43pmol／L，FT4 38．36pmol／L，促甲状腺素未测到。尽管进行对症、支持及抗感染治疗，其甲状腺危象仍然存在。次日凌晨患者突然意识丧失，经抢救无效死亡。

Death from aplastic anemia and thyroid crisis due to inappropriate treatment with methimazole

A 40-year-old woman with hyperthyrosis took methimazole 10 mg thrice daily. More than 1 month later, she developed a high fever, pain around the anus. Laboratory test revealed leucopenia. Methimazole was stopped immediately. Despite of administration with metronidazole and cefuroxime for anti-infection, her symptom did not resolve. She also developed palpitation, chest distress, anorexia, and oliguria. Five days later, she was hospitalized. She had a body temperature of 40 ℃, a pulse rate of 140 beats/min, a respiratory rate of 30 breaths/min, and a BP of 60/30 mmHg. Physical examination showed sporadic petechia on her limbs, a 1.5 cm×1.5 cm perianal ulcer with purulent secretion. Her WBC count was 0.4× 10^9/L with 0. 16 neutrophils. Her haemoglobin level was 94 g/L, and her platelet count was 11 × 10^9/L. A bone marrow biopsy revealed hypoplasia with a myeloid to erythroid cell ratio of 0.5：1, few leucocytes and erythrocytes, non megacaryocyte, less platelets, lymphocytes 0.51, plasmocytes 0.13, and reticulocytes 0. 345. The blood biochemical test revealed the following levels： K^＋ 2.9 mmol/L, Na^＋ 134 mmol/L, Ca^2＋ 1.6 mmol/L, AST 53 U/L, ALT 207 U/L, albumin 20 g/L, and total protein 48 g/L. A thyroid function examination showed that her free T3 and free T4 levels were 38.43 pmol/L and 38. 36 pmol/L, respectively, and her thyrotropin level was undetected. Despite symptomatic, supportive, and anti-infective treatment, her thyroid crisis remained so. The next morning, she suddenly developed unconsciousness. The resuscitation failed of success, and then she died.