Rash and cholestatic liver injury caused by methimazole in a woman with Turner syndrome and Graves's disease: a case report and literature review.

BACKGROUND: Rash and cholestatic liver injury caused by methimazole (MMI) in patients with Turner syndrome (TS) and Graves's disease (GD) are rarely reported, and there is a paucity of reports on the management of this condition. It is not clear whether propylthiouracil (PTU) can be used as a safe alternative in this case. CASE PRESENTATION: A 37-year-old woman was admitted to our hospital with rash, severe pruritus and a change in urine colour after 2 months of GD treatment with MMI. Physical examination showed rash scattered over the limbs and torso, mild jaundice of the sclera and skin, short stature, facial moles, immature external genitals and diffuse thyroid gland enlargement. Liver function tests indicated an increase in total bilirubin, direct bilirubin, total bile acid, glutamic pyruvic transaminase, glutamic oxaloacetic transaminase and alkaline phosphatase. The level of sex hormones suggested female hypergonadotropic hypogonadism. The karyotype of peripheral blood was 46, X, i(X)(q10)/45, X. After excluding biliary obstruction and other common causes of liver injury, combined with rash and abnormal liver function following oral administration of MMI, the patient was diagnosed as having TS with GD and rash and cholestatic liver injury caused by MMI. MMI was immediately discontinued, and eleven days after treatment with antihistamine and hepatoprotective agents was initiated, the rash subsided, and liver function returned to nearly normal. Because the patient did not consent to administration of 131I or thyroid surgery, hyperthyroidism was successfully controlled with PTU. No adverse drug reactions were observed after switching to PTU. CONCLUSIONS: While patients with TS and GD are undergoing treatment with MMI, their clinical manifestations, liver functions, and other routine blood test results should be closely monitored. When patients with TS and GD manifest adverse reactions to MMI such as rash and cholestatic liver injury, it is necessary to discontinue MMI and treat with antihistamine and hepatoprotective agents. After the rash subsides and liver function returns to nearly normal, PTU can effectively control hyperthyroidism without adverse drug reactions.

[Treatment of infected bone defect with one stage open cancellous bone grafting].

OBJECTIVE: To explore the feasibility of the treatment of infected bone defect with one stage open cancellous bone grafting and summarize the key factors improving the curative effects. METHODS: Twelve cases of infected bone defects were reviewed, which involved 8 male and 4 female with an average age of 42 years (range, 22 to 68 years). The study consisted of 7 cases of calcaneal defects, 4 tibial defects and 1 femoral defect. The procedure included dressing change, resection of the devitalized soft tissue and bone tissue. After the debridement, the bone defect at one stage was treated with cancellous bone grafting and the wound was open. The wound was closed with skin transplantation when it was covered by granulation tissue completely. RESULTS: The wound was covered with granulation tissue in the average 24.1 days after operation and was closed in the average 30.3 days. All the patients were followed up for 8 to 30 months with an average time of 18 months. All the bone defects were healing after bone grafting and there was no infection recurrence. CONCLUSION: One stage open cancellous bone graft is an easy and feasible treatment for infected bone defect. Resecting of the devitalized tissue before operation, radical debridement, enough bone graft in operation and careful dressing change after operation are all the key factors to acquire the satisfactory outcome.