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Peer-reviewedCC BY-NC-NDInternal Medicine

A Diagnostic Pitfall: Acute Myeloid Leukemia Mimicking Methimazole-induced Agranulocytosis

  • Satoshi Mitsuyuki
  • Takuya Omura
  • Takahiro Kamihara
  • Akira Katsumi
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Abstract

Methimazole is widely used for treating Graves' disease and it is a well-recognized cause of agranulocytosis. However, this assumption may delay the diagnosis of underlying hematologic disorders. A woman in her early 50s with Graves' disease had been treated with methimazole for 24 years. Routine laboratory testing revealed neutropenia, accompanied by mild anemia and thrombocytopenia. Despite the withdrawal of methimazole, cytopenia persisted. One month later, circulating blasts appeared, and a diagnosis of acute myeloid leukemia was made based on a bone marrow examination. Persistent cytopenia after the discontinuation of methimazole, particularly with multilineage involvement, should prompt an early evaluation for bone marrow disorders.

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Cite

BibTeXRIS
BibTeX
@article{mitsuyuki2026diagnostic,
  title = {{A Diagnostic Pitfall: Acute Myeloid Leukemia Mimicking Methimazole-induced Agranulocytosis}},
  author = {Satoshi Mitsuyuki and Takuya Omura and Takahiro Kamihara and Akira Katsumi},
  journal = {Internal Medicine},
  year = {2026},
  month = jul,
  doi = {10.2169/internalmedicine.7470-26},
  url = {https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7470-26/_article},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - A Diagnostic Pitfall: Acute Myeloid Leukemia Mimicking Methimazole-induced Agranulocytosis
AU  - Satoshi Mitsuyuki
AU  - Takuya Omura
AU  - Takahiro Kamihara
AU  - Akira Katsumi
PY  - 2026
DA  - 2026/07/04
JO  - Internal Medicine
DO  - 10.2169/internalmedicine.7470-26
UR  - https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7470-26/_article
AB  - Methimazole is widely used for treating Graves' disease and it is a well-recognized cause of agranulocytosis. However, this assumption may delay the diagnosis of underlying hematologic disorders. A woman in her early 50s with Graves' disease had been treated with methimazole for 24 years. Routine laboratory testing revealed neutropenia, accompanied by mild anemia and thrombocytopenia. Despite the withdrawal of methimazole, cytopenia persisted. One month later, circulating blasts appeared, and a diagnosis of acute myeloid leukemia was made based on a bone marrow examination. Persistent cytopenia after the discontinuation of methimazole, particularly with multilineage involvement, should prompt an early evaluation for bone marrow disorders.
SN  - 1349-7235
SN  - 0918-2918
ER  -