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Stomatologia 2002, 59(3):120-124
Case report
AGRANULOCYTOSIS WITH CLINICAL MANIFESTATIONS
OF ULCER-NECROTIC GINGIVITIS
AND BILATERAL NECK LYMPHFADENITIS AFTER THIAMAZOLE THERAPY
V.A. SEVASTIANOS, S.P. DOURAKIS, I. MELAKOPOULOS,
S. GAVRIIL, CH. DENDRINOS, TH. KALMANTIS
SUMMARY Thiamazole or methimazole is one of imidazole derivates used as therapy of choice for hyperthiroidism. Agranulocytosis as adverse reaction to methimazole therapy constitutes classical knowledge, however sparse bibliographic information is related to its clinical manifestations from oral cavity. A case of a female patient 27 years old with fever, agranulocytosis, ulcer-necrotic gingivitis and bilateral neck lymphadenitis is described. The patient has been receiving methimazole for two months, for the therapy of hyperthiroidism. After exclusion of other known causes of agranulocytosis the complication was attributed to methimazole. The drug was discontinued and the clinical picture of the patient was improved 18 days later. Myelotoxicity is presumably attributed to idiosyncratic adverse reaction to drug. In conclusion, methimazole may induce agranulocytosis with clinical manifestations from the oral cavity, which can be confused with other causes of ulcerating gingivitis. Administration of the drug must be immediately withdrawn, to prevent the further progress of complication, which some times may be lethal.
KEY WORDS: Methimazole, Drug induced agranulocytosis, Ulcer-necrotic gingivitis.
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