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Propylthiouracil-Induced neutropenia coinciding with newly diagnosed Crohn’s disease

Yıl 2025, Cilt: 4 Sayı: 3, 113 - 117, 31.12.2025
https://doi.org/10.58651/jomtu.1835987

Öz

Agranulocytosis is a serious side effect of antithyroid drugs (ATDs) in patients with hyperthyroidism. Diabetic ketosis is an acute complication of diabetes mellitus (DM) that can be triggered by conditions such as infection, stress, and noncompliance with treatment. Crohn’s disease (CD) is a chronic inflammatory disease of the digestive system and can present with life-threatening complications such as intestinal perforation. A 42-year-old woman with a history of DM, epilepsy, and hyperthyroidism presented with fatigue, sore throat, and joint pain. This is a rare case of Crohn’s disease diagnosed after an intestinal perforation during insulin infusion, plasmapheresis, and steroid therapy following diabetic ketoacidosis and neutropenia. This case highlights the coexistence of these three rare conditions in a single patient.

Kaynakça

  • 1) Antar SA, Ashour NA, Sharaky M, Khattab M, Ashour NA, Zaid RT, Roh EJ, Elkamhawy A, Al-Karmalawy AA. Diabetes mellitus: Classification, mediators, and complications; A gate to identify potential targets for the development of new effective treatments. Biomed Pharmacother. 2023 Dec;168:115734. doi: 10.1016/j.biopha.2023.115734. Epub 2023 Oct 17. PMID: 37857245.
  • 2) MacKay M, Clewis MC, Sweet P. Antithyroid Drug-Induced Agranulocytosis: A Case Report. Cureus. 2023 Nov 4;15(11):e48264. doi: 10.7759/cureus.48264. PMID: 38054132; PMCID: PMC10695326.
  • 3) Cockburn E, Kamal S, Chan A, Rao V, Liu T, Huang JY, Segal JP. Crohn’s disease: an update. Clin Med (Lond). 2023 Nov;23(6):549-557. doi: 10.7861/ clinmed.2023-0493. PMID: 38065612; PMCID: PMC11298500.
  • 4) Kim JW, Lee HS, Ye BD, Yang SK, Hwang SW, Park SH, et al. Incidence of and risk factors for free bowel perforation in patients with Crohn’s disease. Dig Dis Sci 2017;62:1607–14.
  • 5) Yoshimura Noh J, Inoue K, Suzuki N, Yoshihara A, Fukushita M, Matsumoto M, Imai H, Hiruma S, Ichikawa M, Koshibu M, Sankoda A, Hirose R, Watanabe N, Sugino K, Ito K. Dose-dependent incidence of agranulocytosis in patients treated with methimazole and propylthiouracil. Endocr J. 2024 Jul 12;71(7):695-703. doi: 10.1507/endocrj.EJ24-0135. Epub 2024 May 3. PMID: 38710619.
  • 6) Jess T, Jensen BW, Andersson M, Villumsen M, Allin KH. Inflammatory Bowel Diseases Increase Risk of Type 2 Diabetes in a Nationwide Cohort Study. Clin Gastroenterol Hepatol . 2020;18:881–888.e1. doi: 10.1016/j. cgh.2019.07.052.
  • 7) Silaghi A, Constantin VD, Socea B, Banu P, Sandu V, Andronache LF, Dumitriu AS, Paunica S. Inflammatory Bowel Disease: Pathogenesis, Diagnosis and Current Therapeutic Approach. Journal of Mind and Medical Sciences. 2022; 9(1):56-77.
  • 8) Francis KL, Alonge KM, Pacheco MC, Hu SJ, Krutzsch CA, Morton GJ, Schwartz MW, Scarlett JM. Diabetes exacerbates inflammatory bowel disease in mice with diet-induced obesity. World J Gastroenterol. 2023 Sep 7;29(33):4991-5004. doi: 10.3748/wjg.v29.i33.4991. PMID: 37731997; PMCID: PMC10507503.
  • 9) Mithoowani S, Cameron L, Crowther MA. Neutropenia. CMAJ. 2022 Dec 19;194(49):E1689. doi: 10.1503/cmaj.220499. PMID: 36535676; PMCID: PMC9829051.
  • 10) Lightner AL, Vogel JD, Carmichael JC, Keller DS, Shah SA, Mahadevan U, Kane SV, Paquette IM, Steele SR, Feingold DL. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Surgical Management of Crohn’s Disease. Dis Colon Rectum. 2020 Aug;63(8):1028-1052. doi: 10.1097/DCR.0000000000001716. PMID: 32692069.
  • 11) Ranasinghe IR, Tian C, Hsu R. Crohn Disease. [Updated 2024 Feb 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
  • 12) Regueiro M, Velayos F, Greer JB, Bougatsos C, Chou R, Sultan S, Singh S. American Gastroenterological Association Institute Technical Review on the Management of Crohn’s Disease After Surgical Resection. Gastroenterology. 2017 Jan;152(1):277-295.e3. doi: 10.1053/j.gastro.2016.10.039. Epub 2016Nov 10. PMID: 27840073.
  • 13) Kucharzik T, Ellul P, Greuter T, Rahier JF, Verstockt B, Abreu C, Albuquerque A, Allocca M, Esteve M, Farraye FA, Gordon H, Karmiris K, Kopylov U, Kirchgesner J, MacMahon E, Magro F, Maaser C, de Ridder L, Taxonera C, Toruner M, Tremblay L, Scharl M, Viget N, Zabana Y, Vavricka S. ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease. J Crohns Colitis. 2021 Jun 22;15(6):879-913. doi: 10.1093/ecco-jcc/jjab052. Erratum in: J Crohns Colitis. 2023 Jan 27;17(1):149. doi: 10.1093/ecco-jcc/jjac104. PMID: 33730753.

Propiltiourasil tedavisine sekonder nötropeni ve Crohn hastalığı birlikteliği

Yıl 2025, Cilt: 4 Sayı: 3, 113 - 117, 31.12.2025
https://doi.org/10.58651/jomtu.1835987

Öz

Agranülositoz, hipertroidi hastalarında antitiroid ilaçların (ATİ) kullanımına bağlı ortaya çıkan ciddi bir yan etkidir. Diyabetik ketoz, diyabetes mellitusun (DM) akut komplikasyonlarından biri olup, enfeksiyon, stres, tedavi uyumsuzluğu gibi durumlarla tetiklenebilir. Crohn hastalığı (CH), sindirim sisteminin kronik enflamatuvar bir hastalığı olup, intestinal perforasyon gibi hayatı tehdit eden komplikasyonlarla kendini gösterebilir. DM, epilepsi ve hipertroidi tanılı 42 yaşında kadın hasta halsizlik, boğaz ağrısı, eklem ağrısı şikâyeti ile başvurdu. Diyabetik ketoz ve nötropeni ile yatırılarak insülin infüzyonu, plazmaferez ve steroid tedavisi sırasında gelişen intestinal perforasyon sonucu crohn tanısı alan nadir bir olgudur. Bu olgu, nadir görülen bu üç durumun eş zamanlılığını vurgulamaktadır.
Anahtar Kelimeler: Diyabetik ketoz, agranülositoz, nötropeni, crohn hastalığı

Kaynakça

  • 1) Antar SA, Ashour NA, Sharaky M, Khattab M, Ashour NA, Zaid RT, Roh EJ, Elkamhawy A, Al-Karmalawy AA. Diabetes mellitus: Classification, mediators, and complications; A gate to identify potential targets for the development of new effective treatments. Biomed Pharmacother. 2023 Dec;168:115734. doi: 10.1016/j.biopha.2023.115734. Epub 2023 Oct 17. PMID: 37857245.
  • 2) MacKay M, Clewis MC, Sweet P. Antithyroid Drug-Induced Agranulocytosis: A Case Report. Cureus. 2023 Nov 4;15(11):e48264. doi: 10.7759/cureus.48264. PMID: 38054132; PMCID: PMC10695326.
  • 3) Cockburn E, Kamal S, Chan A, Rao V, Liu T, Huang JY, Segal JP. Crohn’s disease: an update. Clin Med (Lond). 2023 Nov;23(6):549-557. doi: 10.7861/ clinmed.2023-0493. PMID: 38065612; PMCID: PMC11298500.
  • 4) Kim JW, Lee HS, Ye BD, Yang SK, Hwang SW, Park SH, et al. Incidence of and risk factors for free bowel perforation in patients with Crohn’s disease. Dig Dis Sci 2017;62:1607–14.
  • 5) Yoshimura Noh J, Inoue K, Suzuki N, Yoshihara A, Fukushita M, Matsumoto M, Imai H, Hiruma S, Ichikawa M, Koshibu M, Sankoda A, Hirose R, Watanabe N, Sugino K, Ito K. Dose-dependent incidence of agranulocytosis in patients treated with methimazole and propylthiouracil. Endocr J. 2024 Jul 12;71(7):695-703. doi: 10.1507/endocrj.EJ24-0135. Epub 2024 May 3. PMID: 38710619.
  • 6) Jess T, Jensen BW, Andersson M, Villumsen M, Allin KH. Inflammatory Bowel Diseases Increase Risk of Type 2 Diabetes in a Nationwide Cohort Study. Clin Gastroenterol Hepatol . 2020;18:881–888.e1. doi: 10.1016/j. cgh.2019.07.052.
  • 7) Silaghi A, Constantin VD, Socea B, Banu P, Sandu V, Andronache LF, Dumitriu AS, Paunica S. Inflammatory Bowel Disease: Pathogenesis, Diagnosis and Current Therapeutic Approach. Journal of Mind and Medical Sciences. 2022; 9(1):56-77.
  • 8) Francis KL, Alonge KM, Pacheco MC, Hu SJ, Krutzsch CA, Morton GJ, Schwartz MW, Scarlett JM. Diabetes exacerbates inflammatory bowel disease in mice with diet-induced obesity. World J Gastroenterol. 2023 Sep 7;29(33):4991-5004. doi: 10.3748/wjg.v29.i33.4991. PMID: 37731997; PMCID: PMC10507503.
  • 9) Mithoowani S, Cameron L, Crowther MA. Neutropenia. CMAJ. 2022 Dec 19;194(49):E1689. doi: 10.1503/cmaj.220499. PMID: 36535676; PMCID: PMC9829051.
  • 10) Lightner AL, Vogel JD, Carmichael JC, Keller DS, Shah SA, Mahadevan U, Kane SV, Paquette IM, Steele SR, Feingold DL. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Surgical Management of Crohn’s Disease. Dis Colon Rectum. 2020 Aug;63(8):1028-1052. doi: 10.1097/DCR.0000000000001716. PMID: 32692069.
  • 11) Ranasinghe IR, Tian C, Hsu R. Crohn Disease. [Updated 2024 Feb 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
  • 12) Regueiro M, Velayos F, Greer JB, Bougatsos C, Chou R, Sultan S, Singh S. American Gastroenterological Association Institute Technical Review on the Management of Crohn’s Disease After Surgical Resection. Gastroenterology. 2017 Jan;152(1):277-295.e3. doi: 10.1053/j.gastro.2016.10.039. Epub 2016Nov 10. PMID: 27840073.
  • 13) Kucharzik T, Ellul P, Greuter T, Rahier JF, Verstockt B, Abreu C, Albuquerque A, Allocca M, Esteve M, Farraye FA, Gordon H, Karmiris K, Kopylov U, Kirchgesner J, MacMahon E, Magro F, Maaser C, de Ridder L, Taxonera C, Toruner M, Tremblay L, Scharl M, Viget N, Zabana Y, Vavricka S. ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease. J Crohns Colitis. 2021 Jun 22;15(6):879-913. doi: 10.1093/ecco-jcc/jjab052. Erratum in: J Crohns Colitis. 2023 Jan 27;17(1):149. doi: 10.1093/ecco-jcc/jjac104. PMID: 33730753.
Toplam 13 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular İç Hastalıkları
Bölüm Olgu Sunumu
Yazarlar

Hacı Mehmet Çitil 0009-0006-3204-3437

Mustafa Eray Dağdeviren 0009-0002-4398-0275

Cevat Gençer 0000-0001-8204-4581

Lezan Keskin 0000-0001-8283-4516

Bahadır Öndeş 0000-0002-8080-9664

Burhan Hakan Kanat 0000-0003-1168-0833

Gökhan Söğütlü 0000-0002-6746-3857

Gönderilme Tarihi 6 Aralık 2025
Kabul Tarihi 23 Aralık 2025
Yayımlanma Tarihi 31 Aralık 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 4 Sayı: 3

Kaynak Göster

APA Çitil, H. M., Dağdeviren, M. E., Gençer, C., … Keskin, L. (2025). Propylthiouracil-Induced neutropenia coinciding with newly diagnosed Crohn’s disease. Journal of Medical Topics and Updates, 4(3), 113-117. https://doi.org/10.58651/jomtu.1835987