A. Mamianetti et al., ACQUIRED SIDEROBLASTIC ANEMIA AND CHOLEST ASIS IN A HYPERTHYROID PATIENT TREATED WITH METHIMAZOLE AND ATENOLOL, Medicina, 55(6), 1995, pp. 693-696
The authors describe a 62 year-old white male who was diagnosed as aut
oimmune hyperthyroidism and treated with methimazole and atenolol. Ten
days later he showed itching, jaundice and choluria. All drugs were d
iscontinued. The patient was given radioactive iodine. Two months late
r direct serum bilirubin levels reached 35 mg%. Endoscopic retrograde
cholangiogram evidenced normal extrahepatic biliary ducts. The percuta
neous liver biopsy showed marked cholestasis specially in the centrolo
bular zone with a slight infiltrate of mononuclear cells in the portal
areas. Together with the liver disease the patient presented an anemi
c syndrome. Bone marrow aspiration showed rich cellularity, Perls stai
ning showed 70% sideroblasts, with 10% ringed sideroblasts and increas
ed extracorpuscular iron. The patient's evolution was satisfactory. Tw
enty months after the beginning of the disease clinical and biochemica
l tests were normal. A new bone marrow aspiration rendered normal. Hep
atic cholestasis suffered by our patient was probably due to an advers
e reaction of methimazole. Physiopathology of reversible sideroblastic
anemia is discussed.