7 PROPYLTHIOURACIL INDUCED ANCA-ASSOCIATED VASCULITIS WITH DIFFUSE ALVEOLAR HEMORRHAGE. (10th December 2015)

• Record Type: Journal Article
• Authors: Blair, Josh G.; Stewart, J. L.; McMurray, R. W.
• Is Part Of: Journal of investigative medicine. Volume 53:Number 1(2005)
• Page Start: S255
• Page End: S255
• Publication Date: 2015-12-10
• Subjects: Clinical medicine -- Periodicals; Medicine -- Research -- Periodicals; Medicine; Research -- United States; Clinical medicine; Medicine -- Research; Periodicals; 616.075
• DOI: 10.2310/6650.2005.00006.6
• Languages: English
• ISSNs: 1081-5589

Abstract

Abstract : The vasculitides are defined by the presence of leukocytes in the vessel wall with reactive damage causing compromise of the vessel wall and bleeding. Propylthiouracil (PTU), a thionamide commonly used in the treatment of hyperthyroidism, is known to have been associated with the development of antineutrophil cytoplasmic antibody (ANCA) positivity. However, only a few of these cases ever develop the sequela that is typically involved with antineutrophil cytoplasmic antibodies. It is postulated that an immune or hypersensitivity reaction to the medication causes the inflammation in the vascular wall. Most often discontinuation of the offending agent results in full recovery. However, in more severe cases treatment with high-dosed steroids and even cyclophosphamide is warranted. We present a case of a 55 year-old Choctaw female with Graves' disease who presented with shortness of breath, dyspnea on minimal exertion, and hemoptysis. Her medications included metoprolol, fosinopril, atorvastatin, metformin, aspirin, propylthiouracil, and naproxen. She was afebrile with moderate respiratory distress and hypoxic. Chest radiograph and CT scan showed a diffuse, patchy interstitial pattern in bilateral lung fields. Laboratory data included a hematocrit was 28.4, ESR 125, CRP 25, positive C-ANCA, and positive P-ANCA. A fiber-optic bronchoscopy showed severely hyperemic mucosa throughout all airways and BAL washings contained mostly blood and inflammatory cells. An open lung biopsy revealed thickened vessel walls and a non-specific interstitial inflammation with edema. With little improvement after withholding PTU, she was treated with high-dosed IV methylprednisolone for three days followed by cyclophosphamide. Within 36 hours of receiving these immunosuppressants, the patient's oxygen was weaned to room air and her hemoptysis completely subsided. To our knowledge, this is only the second case reported of both P- and C-ANCA positive vasculitis with diffuse alveolar hemorrhage during the course of PTU therapy.