Journal List > J Korean Endocr Soc > v.22(3) > 1003363

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Sun, Kim, Lee, Lee, Kim, Kim, Cho, Ko, Kim, Kim, Song, and Ahn: A Case of Antineutrophil Cytoplasmic Antibody (ANCA) Positive, Propylthiouracil-Induced Diffuse Alveolar Hemorrhage in Graves' Disease
Case Report
Journal of Korean Endocrine Society

Journal of Korean Endocrine Society 2007; 22(3): 215-219.

Published online: 20 June 2007

DOI: https://doi.org/10.3803/jkes.2007.22.3.215

A Case of Antineutrophil Cytoplasmic Antibody (ANCA) Positive, Propylthiouracil-Induced Diffuse Alveolar Hemorrhage in Graves' Disease

Der Sheng Sun, Dong Kyu Kim, Hyo Jin Lee, Hee Yun Lee, Dae Jun Kim, Eun Sook Kim, Jae Hyoung Cho, Seung Hyun Ko, Wan Ook Kim, Chi Hong Kim, Ki Ho Song, Yu Bae Ahn

Department of Internal Medicine, The Catholic University College of Medicine, Korea.

Received 2 March 2007       Accepted 30 March 2007

Copyright © 2007 Korean Endocrine Society

Abstract

Graves' disease is one of the common autoimmune diseases, and it has been controlled by such antithyroid drugs as propylthiouracil (PTU) or methimazole. There are a number of side effects, including agranulocytosis, skin rash, hepatotoxicity, fever, arthralgia and a lupus-like syndrome during treatment. PTU has been recently observed to be associated with the development of antineutrophil cytoplasmic antibody (ANCA) positive vasculitis, and this can cause diffuse alveolar hemorrhage. A 32-year-old woman with Graves' disease had been treated with PTU for 4 years, and she had experienced intermittent hemoptysis for 2 weeks before she visited the hospital. Both myeloperoxidase and proteinase 3 ANCA were positive without other organ systems being involved. She was diagnosed with PTU-induced vasculitis. Cessation of PTU and administration of corticosteroids improved the clinical manifestations.

Keywords: Antineutrophil cytoplasmic antibody (ANCA), Diffuse alveolar hemorrhage (DAH), Propylthiouracil (PTU)

Figures and Tables

Fig. 1
A. Initial chest X-ray. Showing diffuse infiltrations in right middle lung field. B. Follow-up chest X-ray. Showing normal lung fields after treatment.
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Fig. 2
A. Initial HRCT. Showing diffuse ground glass opacity in right middle lung. B. Follow-up HRCT. Showing improvement of ground glass opacity in right midde lung.
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Fig. 3
Bronchoscopy. Showing normal findings.
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References

1. Berkman EM, Orlin JB, Wolfsdorf J. An anti-neutrophil antibody associated with a propylthiouracil-induced lupus-like syndrome. Transfusion. 1983. 23:135–138.
2. Dhillon SS, Singh D, Doe N, Qadri AM, Ricciardi S, Schwarz MI. Diffuse alveolar hemorrhage and pulmonary capillaritis due to propylthiouracil. Chest. 1999. 116:1485–1488.
3. Yamauchi K, Sata M, Machiya J, Osaka D, Wada T, Abe S, Otake K, Kubota I. Antineutrophil cytoplasmic antibody positive alveolar haemorrhage during propylthiouracil therapy for hyperthyroidism. Respirology. 2003. 8:532–535.
4. Lee SY, Jung JY, Lee KJ, Lee SH, Kim SJ, Lee EJ, Hur GY, Jung HC, Kim JH, Shin C, Shim JJ, In KH, Kang KH, Yoo SH. A case of propylthiouracil induced diffuse pulmonary hemorrhage. Tuberc Respir Dis. 2005. 58:78–82.
5. Kang AY, Baek YH, Sohn YJ, Lee SK, Son CH, Kim K, Yang DK. Diffuse alveolar hemorrhage associated with antineutrophil cytoplasmic antibody levels in a pregnant woman taking propylthiouracil. Korean J Intern Med. 2006. 21:240–243.
6. Dolman KM, Gans RO, Vervaat TJ, Zevenbergen G, Maingay D, Nikkels RE, Donker AJ, von dem Borne AE, Goldschmeding R. Vasculitis and antineutrophil cytoplasmic autoantibodies associated with propylthiouracil therapy. Lancet. 1993. 342:651–652.
7. Romas E, Henderson DR, Kirkham BW. Propylthiouracil therapy: an unusual cause of antineutrophil cytoplasmic antibody associated alveolar hemorrhage. J Rheumatol. 1995. 22:803.
8. Ohtsuka M, Yamashita Y, Doi M, Hasegawa S. Propylthiouracil-induced alveolar haemorrhage associated with antineutrophil cytoplasmic antibody. Eur Respir J. 1997. 10:1405–1407.
9. Harper L, Cockwell P, Savage CO. Case of propylthiouracil-induced ANCA associated small vessel vasculitis. Nephrol Dial Transplant. 1998. 13:455–458.
10. Yoshitaka N, Takayuki T, Yasushi I, Kenji S. Propylthiouracil (PTU)-induced vasculitis associated with antineutrophil antibody against myeloperoxidase (MPO-ANCA). Int Med. 2003. 42:529–533.
11. Gunton JE, Stiel J, Caterson RJ, McElduff Al. Clinical case seminar: anti-thyroid drugs and antineutrophil cytoplasmic antibody positive vasculitis. a case report and review of the literature. J Clin Endocrinol Metab. 1999. 84:13–16.
12. Harper L, Chin L, Daykin J, Allahabadia A, Heward J, Gough SC, Savage CO, Franklyn JA. Propylthiouracil and carbimazole associated-antineutrophil cytoplasmic antibodies (ANCA) in patients with Graves' disease. Clin Endocrinol. 2004. 60:671–675.
13. Jiang X, Khursigara G, Rubin RL. Transformation of lupus-inducing drugs to cytotoxic products by activated neutrophils. Science. 1994. 266:810–813.
14. von Schmiedeberg S, Goebel C, Gleichmann E, Uetrecht J. Neutrophils and drug metabolism. Science. 1995. 268:585–586.
15. Choi HK, Merkel PA, Tervaert JW, Black RM, McCluskey RT, Niles JL. Alternating antineutrophil cytoplasmic antibody specificity: drug-induced vasculitis in a patient with Wegener's granulomatosis. Arthritis Rheum. 1999. 42:384–388.
16. Hogan SL, Nachman PH, Wilkman AS, Jennette JC, Falk RJ. Prognostic markers in patients with antineutrophil cytoplasmic autoantibody-associated microscopic polyangitis and glomerulonephritis. J Am Soc Nephrol. 1996. 7:23–32.
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