Propylthiouracil
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Lupus, strokes and antiphospholipid syndrome: case report A 27-year-old man developed lupus, initially manifesting as ischaemic strokes, while receiving propylthiouracil for hyperthyroidism. He was eventually diagnosed with antiphospholipid syndrome. The man had been receiving propylthiouracil 150mg three times daily [route not stated] and metoprolol for 2 weeks when he presented with double vision and numbness of his right arm and face, for approximately 24 hours. Examination revealed a diffusely enlarged thyroid gland and a pulse rate of 109 bpm. He displayed right gaze palsy, right homonymous hemianopsia, vertical nystagmus, and mild right pronator drift. Brain MRI showed acute ischaemic strokes in the left thalamus, left occipital lobe, and right cerebellum, and lumen irregularities were evident in the right posterior cerebral artery. Laboratory analysis was notable for a prolonged partial thromboplastin time, mild elevation of his anticardiolipin IgA level, a positive lupus anticoagulant test result, and the presence of anti-double-stranded DNA (anti-dsDNA), Sjogren and antinuclear antibodies. The man was initially treated with anticoagulation therapy, β-adrenergic receptor antagonists, and the withdrawal of propylthiouracil. An embolic detection study demonstrated two high-intensity transient signals in the basilar artery, and an echocardiogram suggested the presence of a patent foramen ovale. A radioactive iodine scan was consistent with Graves’ disease, and radioactive iodine ablation was initiated. The man’s neurological deficits improved during his hospital stay and he made a full recovery. His hyperthyroidism had resolved and his anti-dsDNA antibody levels had normalised 3 months after ablation therapy. During the following 12 months, his anticardiolipin IgA level normalised but his anticardiolipin IgG level increased and remained high. He was stable during follow-up, with no further thromboembolic episodes or clinical manifestations of connection tissue disorders. Ortiz GA, et al. Propylthiouracil-induced lupus, antiphospholipid syndrome, and stroke in a patient with graves hyperthyroidism. Archives of Neurology 68: 803067689 1587-1590, No. 12, Dec 2011 - USA
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Reactions 3 Mar 2012 No. 1391
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