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ANCA vasculitis: case report A 40-year-old woman developed drug-induced ANCA vasculitis during treatment with propylthiouracil and thiamazole [methimazole] for Graves’ disease. She developed vasculitis again when she was treated with infliximab for Crohn’s disease. The woman had a history of Graves’ disease and was initially treated with propylthiouracil and thiamazole [routes, dosages, and durations of treatments to reaction onset not stated]. She developed drug-induced ANCA vasculitis and sequelae included pericardial effusion, pleural effusions, proteinuria, and haematuria. Her symptoms improved after initiation of corticosteroids and the withdrawal of her thyroid drugs. Her symptoms completely resolved and she was asymptomatic for 18 months. She then presented with bloody diarrhoea. Endoscopy revealed severe colonic ulceration in the sigmoid colon and descending colon with skip areas of uninflamed mucosa. She received corticosteroids but her symptoms didn’t improve after 14 days and she was treated with infliximab [route and dosage not stated; duration of treatment to reaction onset not clearly stated]. There was no response after 10 days and she underwent total abdominal colectomy with end ileostomy. Histopathology confirmed Crohn’s disease. She developed symptomatic pleural effusions, myalgias, chest pain, arthralgias, anaemia, and leucopenia. She also had recurrence of a vesiculobullous rash on her back and lower extremity purpuric lesions. There was concern that this was a second episode of drug-induced vasculitis (DIV). Serology showed positive ANA, a C4 value of 15.3 mg/dL, negative antiSmith and negative anti-DS DNA. Anti-myeloperoxidase antibodies showed a significant increase. The woman was treated with corticosteroids and her infliximab was discontinued. She made a full recovery. Author comment: "There is literature to suggest a reasonable connection between [thiamazole] and propylthiouracil administration and DIV. . . our patient received a biologic in an effort to treat her inflammatory bowel disease, but in fact developed a DIV as a result." Rosen DR, et al. Recurrent drug-induced ANCA vasculitis in a patient with Crohn’s colitis treated with infliximab: A potential contraindication to immunosuppressive therapy. American Surgeon 78: 1406-1408, No. 12, Dec 2012 803085494 - USA

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Reactions 13 Apr 2013 No. 1447