吉林大学学报(医学版) ›› 2024, Vol. 50 ›› Issue (5): 1414-1419.doi: 10.13481/j.1671-587X.20240527

• 临床医学 • 上一篇    

Graves病患者应用甲巯咪唑导致反应性浆细胞增多症1例报告及文献复习

李时孟1(),齐新1,林思彤2,伞湘雯1,金玲1,张斯童1   

  1. 1.吉林大学中日联谊医院检验科,吉林 长春 130033
    2.吉林大学中日联谊医院内分泌科,吉林 长春 130033
  • 收稿日期:2023-09-24 出版日期:2024-09-28 发布日期:2024-10-28
  • 通讯作者: 李时孟 E-mail:lishimeng@jlu.edu.cn
  • 作者简介:李时孟(1990-),女,吉林省长春市人,主治医师,医学博士,主要从事临床血液学检验细胞形态分析方面的研究。
  • 基金资助:
    吉林省科技厅科研项目(20230203073SF)

Reactive plasmacytosis caused by methimazole in patients with Graves’ disease: One case report and literature review

Shimeng LI1(),Xin QI1,Sitong LIN2,Xiangwen SAN1,Ling JIN1,Sitong ZHANG1   

  1. 1.Department of Clinical Laboratory,China-Japan Union Hospital,Jilin University,Changchun 130033,China
    2.Department of Endocrinology,China-Japan Union Hospital,Jilin University,Changchun 130033,China
  • Received:2023-09-24 Online:2024-09-28 Published:2024-10-28
  • Contact: Shimeng LI E-mail:lishimeng@jlu.edu.cn

摘要:

目的 探讨Graves病(GD)患者应用甲巯咪唑(MMI)治疗后出现粒细胞缺乏症和反应性浆细胞增多症(RP)的临床表现和实验室检查结果,为临床医生鉴别诊断RP和多发性骨髓瘤(MM)提供依据。 方法 分析1例GD粒细胞缺乏症并发RP患者的临床表现、实验室检查和诊治过程,并进行文献复习。 结果 患者有GD和腹腔感染病史,入院查血常规白细胞计数明显降低且伴有中性粒细胞缺乏,涂片复检见可疑浆细胞。骨髓细胞学检查,骨髓浆细胞百分率为33%,外周血浆细胞百分率为4%;血清免疫球蛋白多克隆性增生;血清免疫固定电泳阴性;流式细胞学分析,浆细胞免疫表型正常。结合病史和实验室检验结果,基本排除MM可能,符合RP的诊断。考虑中性粒细胞缺乏与用药有关,暂停MMI,给予粒细胞集落刺激因子升高白细胞数,控制腹腔感染后进行GD专科治疗。患者预后良好,6个月后随访复查血常规正常。 结论 GD患者出现粒细胞缺乏症并发RP在临床上较为罕见,血清免疫固定电泳、血细胞形态学和细胞免疫表型分析有助于明确诊断。积极治疗RP原发疾病后,患者预后良好。

关键词: 甲巯咪唑, Graves病, 浆细胞, 粒细胞缺乏症, 诊断

Abstract:

Objective To discuss the clinical manifestations and laboratory examination results of agranulocytosis and reactive plasmacytosis (RP) in the patient with Graves’ disease (GD) after treated with methimazole (MMI), and to provide the basis for the clinicians to differentiate RP from multiple myeloma (MM). Methods The clinical manifestations, laboratory examinations, diagnosis and treatment processes of one patient with GD agranulocytosis complicated with RP were analyzed, and the related literatures were reviewed. Results The patient had a history of GD and abdominal infection. Upon admission, a complete blood count revealed a significant decrease in white blood cell count accompanied by neutropenia, and a smear re-examination showed suspicious plasma cells.The bone marrow cytology examination results showed the percentage of bone marrow plasma cells was 33%, and the percentage of plasma cells in peripheral blood was 4%; the serum immunoglobulin results showed polyclonal hyperplasia; the serum immunofixation electrophoresis results were negative; the flow cytometry analysis results indicated the immunophenotype of the plasma cells was normal. Based on the medical history and laboratory results, MM was largely excluded, supporting the diagnosis of RP. Neutropenia was considered to be related to medication, so MMI was discontinued, granulocyte colony-stimulating factor was administered to increase the number of white blood cells, and specialized GD treatment was conducted after controlling the abdominal infection. The patient had a good prognosis, and his blood count was normal upon re-examination 6 months later. Conclusion Agranulocytosis complicated with RP in the GD patients is clinically rare. Serum immunofixation electrophoresis, blood cell morphology, and cell immunophenotype analysis are helpful for the accurate diagnosis. After actively treating the primary disease causing RP, the patient’s prognosis is favorable.

Key words: Methimazole, Graves’ disease, Plasma cell, Agranulocytosis, Diagnosis

中图分类号: 

  • R736.1