Propylthiouracil-associated antineutrophil cytoplasmic antibodies resulted microscopic polyangiitis and pulmonary-renal syndrome: A case report and literature review
Journal
Journal of Internal Medicine of Taiwan
Journal Volume
16
Journal Issue
5
Pages
230-235
Date Issued
2005
Author(s)
Abstract
Propylthiouracil (PTU) is a thionamide used for hyperthyroidism. Numbers of PTU induced adverse reactions such as leukopenia, rash, fever, arthritis, vasculitis, and lupus-like syndrome are reported. In addition, antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis during PTU therapy was reported. Pulmonary-renal syndrome is one infrequent but life-threatening presentation of PTU-associated ANCA-positive vasculitis. We report a 45-year-old woman with pulmonary-renal syndrome presented as hemoptysis, normocytic anemia, and microscopic hematuria during the treatment of Graves' disease with PTU. Her serum perinuclear-ANCA was positive and dysmorphic red blood cells were found in urinalysis. After discontinuing PTU and starting immunosuppressive agent treatment, the fever, hematuria, and pulmonary hemorrhage subsided but the p-ANCA was still present several months later. ANCA-associated pulmonary-renal syndrome may be a complication of PTU therapy. The proportion of ANCA-positive case increases with the prolongation of PTU therapy. In contrast, there are rare reports of ANCA-associated vasculitis in the other thionamide i.e. carbimazole and methimazole. Therefore, carbimazole or methimazole may be the drug of choice when long-term treatment for hyperthyroidism is required.
SDGs
Other Subjects
acetylsalicylic acid; azithromycin; C reactive protein; carbimazole; creatinine; cyclophosphamide; glucocorticoid; hemoglobin; hydroxychloroquine; immunosuppressive agent; iodine 131; liothyronine; methylprednisolone; neutrophil cytoplasmic antibody; nitrogen; propylthiouracil; sultamicillin; thiamazole; thyrotropin; thyroxine; urea; adult; ANCA associated vasculitis; anemia; arthralgia; article; capillaritis; case report; computer assisted tomography; drug dose regimen; drug fatality; drug withdrawal; erythrocyte volume; exophthalmos; eye disease; female; fever; glomerulonephritis; Graves disease; hematuria; hemoptysis; human; leukocyte count; low drug dose; lung hemorrhage; lung tuberculosis; microscopic polyangiitis; myalgia; partial thromboplastin time; pneumonia; rhinorrhea; sore throat; thorax radiography; thrombocyte count; urea nitrogen blood level; urinalysis; urticaria
Type
journal article