Development of anti-neutrophil-cytoplasmic-antibody associated vasculitis in a patient with Grave's disease treated with propylthiouracil for 17 years: a case report and literature review

葛瑞夫茲氏病（Graves' disease）使用Propylthiouracil治療17年後引起之ANCA相關血管炎－個案報告與文獻回顧

張維修(Wei-Hsiu Chang) ； 曾健華(Chien-Hua Tseng) ； 林俊佃(Jiunn-Diann Lin) ； 廖家德(Chia-Te Liao) ； 林聖閎(Sheng-Hong Lin)

《Formosan Journal of Rheumatology》 36卷2期 (2022/12) Pp. 95-101

https://doi.org/10.6313/FJR.202212_36(2).0011

摘要

Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) causes significant organ damage if not diagnosed and treated early, and life-threatening complications, such as pulmonary hemorrhage and renal failure, may occur even if the causal medication is discontinued. We presented a case of 41-year-old woman with 17-year history of hyperthyroidism treated with propylthiouracil, and suffered from pulmonary hemorrhage and rapidly progressive glomerulonephritis but without a skin rash. Plasmapheresis was promptly done ten times upon admission. Methylprednisolone pulse therapy was provided during plasmapheresis. Her hemoptysis improved, and her creatinine and hemoglobin levels started to return to baseline. After receiving complete therapy, the patient was discharged from the intensive critical unit and followed in the outpatient clinic without significant organ damage.

關鍵字

ANCA-associated vasculitis ； pulmonary-renal syndrome ； plasmapheresis ； propylthiouracil

並列摘要

ANCA類血管炎症狀表現多樣化，也有機率造成肺出血與快速進行性的腎絲球腎炎等表徵。藥物引發的ANCA類血管炎一般停藥後症狀可明顯改善，但若無即時處置，仍偶有機率會出現生命危險的表現。我們報告一位41歲女性，因甲狀腺功能異常長期服用Propylthiouracil藥物達17年之久，引發ANCA血管炎與肺腎症候群的個案，同時文獻回顧關於使用Propylthiouracil藥物的治療時間與引發ANCA血管炎的關聯性、血漿置換對於ANCA類血管炎合併肺腎症候群的病人是否仍有助益，以及佐證應用尿蛋白／尿中白蛋白與尿液肌酸酐比值監測殘餘腎功能。

並列關鍵字

ANCA相關血管炎 ； 肺腎症候群 ； 血漿置換 ； Propylthiouracil