Propylthiouracil and Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis: A Case Report and Literature Review

Hsin-Yueh Liu ； Chien-Wen Chou ； Chwen-Yi Yang ； Feng-Chieh Yen ； Mei-Chen Yeh ； Kai-Jen Tien

《Formosan Journal of Endocrinology and Metabolism》 6卷1期 (2015/06) Pp. 30-34

https://doi.org/10.6856/FJEM.201506_6(1).0005

摘要

Background. Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is an autoimmune disease occurs as primary or secondary (drug-, malignancy- or infection-induced) disorder. Propylthiouracil (PTU), one of the most commonly used antithyroid agent, may induce ANCA-associated vasculitis. Although most patients with PTU-induced AAV have favorable prognosis, some could face life-threatening conditions. Methods. We report a woman who had hyperthyroidism and received PTU treatment for 23 months. She developed PTU-induced AAV complicated with diffuse crescentic glomerulonephritis and acute pulmonary hemorrhage. Results. The 61-year-old woman received PTU treatment for hyperthyroidism in the past 23 months. She reported urinary frequency, hematuria, and decreased urine amount for one month. She also had fever, hemoptysis and dyspnea for 2 days. After admission, acute renal failure developed and required emergent hemodialysis. During dialysis, acute pulmonary edema with respiratory failure emerged and managed with endotracheal intubation and mechanical ventilation. Bronchoscopy examinations revealed pulmonary hemorrhage. Laboratory data demonstrated elevated serum titers of perinuclear ANCA and cytoplasmic ANCA. Histologic assessment of renal biopsy demonstrated perinuclear ANCA- associated diffuse crescentic glomerulonephritis. PTU was discontinued. Aggressive treatments, including plasmapheresis, pulse steroid therapy and cyclophosphamide administration leaded to an improvement of pulmonary hemorrhage, while end stage renal disease remained. Conclusion. PTU-induced AAV can be a life-threatening autoimmune disease. Clinician should be aware of this adverse effect of the commonly used agent PTU.

關鍵字

propylthiouracil ； anti-neutrophil cytoplasmic antibody ； vasculitis ； glomerulonephritis-pulmonary hemorrhage