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Open Access

Severe and prolonged febrile agranulocytosis under thyrosol

  • Mihaela Ionică1,
  • Roxana Geantă1Email author,
  • Șerban Benea1,
  • Bogdana Manu1,
  • Alina Cozma1,
  • Mihai Olariu1,
  • Olga Dorobăț1,
  • Cleo Roşculeț1,
  • Ramona Zamfir1,
  • Adrian Miron2 and
  • Elisabeta Benea1
BMC Infectious Diseases201414(Suppl 7):P96

Published: 15 October 2014


NeutropeniaPseudomonas AeruginosaFebrile NeutropeniaTotal ThyroidectomyAortic Regurgitation


It is well known that patients with severe neutropenia are susceptible to bacterial infections, which may become life-threatening. This hematologic disorder frequently occurs as an adverse effect of certain drug therapies. One of them, currently encountered in practice, is therapy with antithyroid drugs. An infective source is identified in average in 20-30% of febrile neutropenia episodes. Often the only infection proof is bacteremia, documented in 10-25% of patients.

Case report

We report the case of a patient known with Basedow-Graves disease, who developed a febrile agranulocytosis under thyrosol, and in which Pseudomonas aeruginosa was isolated from blood culture. Although the antibiotic treatment proved efficient and the patient recovered the neutropenia due to granulocyte colony-stimulating factor, the initial evolution was unfavorable, due to the impossibility of continuing antithyroid treatment and due to a heart rhythm disorder that appeared subsequently, on the patient’s background of mitral and aortic regurgitation. During hospitalization, a transfer to the intensive care department was necessary.

After the remission of agranulocytosis, the patient underwent total thyroidectomy, because of an absolute contraindication of ever using thyrosol therapy. At 3 months of follow-up, the patient is on thyroid substitution, and is stable.


Despite an initially poor prognosis, the eventual evolution was favorable, through interdisciplinary cooperation between infectious diseases, endocrinology, hematology, cardiology, intensive care and surgery.


Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.

Authors’ Affiliations

National Institute for Infectious Diseases "Prof. Dr. Matei Balş", Bucharest, Romania
Elias University Emergency Hospital, Bucharest, Romania


© Ionică et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.