Propylthiouracil
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Anti-neutrophil cytoplasmic antibody-associated vasculitis: case report A 20-year-old woman developed anti-neutrophil cytoplasmic antibody-associated systemic vasculitis during treatment with propylthiouracil for Graves’ disease. About 2 years before hospitalisation, the woman had begun receiving propylthiouracil 300 mg/day, and was then maintained on propylthiouracil 100 mg/day. Five months before admission, her propylthiouracil dose was increased to 300 mg/day. Soon after, she started to report muscle pain, arthralgia and skin eruptions [time of reaction onset not clearly stated]. Three months before admission, she developed haemoptysis, a cough and gross haematuria. Subsequently, she also developed ‘red eye’, weight loss and a gradual decline in her hearing. One week before admission, her propylthiouracil dose was increased to 450 mg/day. She then became severely unwell with massive pulmonary haemorrhage, and was referred to hospital with gross haematuria and pulmonary haemorrhage. On admission, an examination revealed paleness, goitre and exophthalmos. She had a pulse rate of 96 beats/min and a respiratory rate of 24 breaths/min. Scattered expiratory wheezes and coarse bronchial breath sounds were revealed by lung auscultation. A cardiac examination showed tachycardia. Laboratory investigations revealed the following levels: haemoglobin 7.8 g/dL (normal 11–15), platelet count 393 x 103/mm3 (100–300), erythrocyte sedimentation rate 120 mm/h (< 20), urinary protein 1.86 (< 0.15), urinary RBC count 80–100, A1b 30.3 g/L (35–55), C3 0.48 g/L (0.85–1.93), positive C-reactive protein, and partial pressure of oxygen 73mm Hg (95–100). Her serum perinuclear cytoplasmic stained pattern on ethanolfixed neutrophil was positive with specificity for lactoferrin, azurocidin and myeloperoxidase. Propylthiouracil-induced anti-neutrophil cytoplasmic antibody-associated systemic vasculitis was diagnosed. Propylthiouracil was discontinued immediately after admission. The woman received plasmapheresis and methylprednisolone pulse therapy. She showed dramatic improvement and her haemoptysis stopped. Four days after admission, her chest radiography became clear. Renal biopsies showed necrotising crescentic glomerulonephritis. She received oral prednisone and IV pulse cyclophosphamide. Within weeks, she had completely recovered. She had no flareup of clinical vasculitis during 3-year follow-up, but her serum perinuclear cytoplasmic stained pattern and antimyeloperoxidase antibodies remained persistently positive with a low titre. Zhao M-H, et al. Propylthiouracil-induced anti-neutrophil cytoplasmic antibodyassociated vasculitis. Kidney International 69: 1477-1481, No. 8, Apr 2006 801040937 China
0114-9954/10/1113-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 5 Aug 2006 No. 1113
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