methimazole and Infections

Aplasia cutis congenita (ACC) is a condition in which localized or widespread areas of skin are absent at birth. Defective lesions show complete absence of all layers of skin, occasionally extending to skull or dura. ACC is etiologically heterogeneous; many different etiologies including teratogens have been documented.. We describe the first reported case of a monozygotic twin with ACC after exposure to methimazole in utero. The female patient was born at 36 weeks gestation as the first child of monozygotic twins. The mother received methimazole between the 11th and 17th weeks of pregnancy because of transient hyperthyroidism. The second child did not have ACC. The patient had defects of the scalp, skull, and dura (7 x 5 cm) on the sagittal line of the parieto-occipital region. No other malformations were noted. The scalp defect has been treated daily with sterile physiological saline and petrolatum dressing in addition to intravenous antibiotics. Trafermin, a recombinant human fibroblast growth factor, was sprayed from day 6 to promote epithelialization of the scalp defect. On day 21, she had high fever due to infection of the defect lesion, which was controlled by povidone iodine dressing and intravenous antibiotics. The defect of the scalp was well healed after 6 weeks, but the skull defect remained unclosed.. We describe a rare case of a monozygotic twin with ACC and skull defect after methimazole exposure in utero. The findings of our case suggest that methimazole is a potential teratogen of ACC.

Topics: Anti-Bacterial Agents; Antithyroid Agents; Ectodermal Dysplasia; Female; Fibroblast Growth Factors; Humans; Hyperthyroidism; Infant, Newborn; Infections; Male; Methimazole; Peptide Fragments; Pregnancy; Pregnancy Complications; Pregnancy Trimester, First; Skull; Twins, Monozygotic

A 26-year-old woman was admitted to hospital with high fever, severe tonsillitis, and gastroenteritis. Because of Graves' disease she had been treated with methimazole for 18 months. Leukopenia and agranulocytosis in combination with a typical bone marrow, exhibiting a complete arrest of myelopoiesis at the stage of promyelocytes led to the diagnosis of an antithyroid therapy induced agranulocytosis. After 1 week of antibiotic treatment without changes in neutrophil counts, granulocyte colony stimulating factor treatment at a dose of 300 micrograms/day subcutaneously was started. Twenty-four hours after the first administration the neutrophil counts began to rise, to 4389/microliters, with a maximum after the third administration and stabilizing at normal levels within 10 days. Since agranulocytosis is considered to be a severe and fatal complication of methimazole therapy, treatment with granulocyte colony stimulating factor seems to be useful for this life-threatening condition.

Topics: Adult; Agranulocytosis; Bone Marrow; Female; Granulocyte Colony-Stimulating Factor; Graves Disease; Humans; Immunologic Factors; Infections; Leukocyte Count; Methimazole

Topics: Adult; Autoradiography; Bacteria; Blood Bactericidal Activity; Child, Preschool; Female; Granuloma; Hexosephosphates; Humans; Hydrogen Peroxide; Infant; Infections; Iodine; Iodine Isotopes; Lactobacillus acidophilus; Leukocytes; Lymphadenitis; Male; Methimazole; Neutrophils; Oxygen Consumption; Peroxidases; Phagocytosis; Serratia marcescens