Acute Onset Methimazole-Induced Arthralgia and Skin Rash

Kyung Hye Park; Jin Hyoung Kim; Se Eun Han; Chan Sung Park; Il Sung Nam-Goong; Young Il Kim; Eun Sook Kim

doi:10.11106/jkta.2014.7.1.83

Journal List > J Korean Thyroid Assoc > v.7(1) > 1056573

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Park, Kim, Han, Park, Nam-Goong, Kim, and Kim: Acute Onset Methimazole-Induced Arthralgia and Skin Rash

Case Report

J Korean Thyroid Assoc 2014;7(1):83-87.

Published online: 29 May 2014

DOI: https://doi.org/10.11106/jkta.2014.7.1.83

Acute Onset Methimazole-Induced Arthralgia and Skin Rash

Kyung Hye Park, Jin Hyoung Kim, Se Eun Han, Chan Sung Park, Il Sung Nam-Goong, Young Il Kim, Eun Sook Kim

Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan Korea

Correspondence: Eun Sook Kim, MD, PhD, Department of Internal Medicine, Ulsan University Hospital, 290-3 Junha-dong, Dong-gu, Ulsan 682-714, Korea Tel: 82-52-250-8837, Fax: 82-52-250-7048, E-mail: endo10@daum.net

Received 6 March 2013 Accepted 17 February 2014

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Methimazole, a type of thionamide, is used to treat hyperthyroidism. Several adverse effects of thionamides have been reported. The representative minor adverse effects are arthralgia, skin rash, and gastric intolerance. Methimazole is reported to induce 1-6% of arthralgia cases. These patients begin to suffer from arthralgia from 1 month to 2 years after methimazole treatment. Here, we present a patient with acute onset methimazole-induced arthralgia and skin rash. At 2 days after starting methimazole treatment, a 57-year-old female developed arthralgia and a skin rash on her right leg, which subsequently spread to her left leg and right arm, and she stopped taking the medication. The patient was admitted to the rheumatology department of Ulsan University Hospital, where laboratory tests and a skin biopsy were performed to ascertain whether she had a rheumatic disorder. The skin biopsy revealed nonspecific inflammation. At 2 days after stopping methimazole treatment, the arthralgia and skin rashes had improved and methimazole treatment was recommenced. However, the same symptoms developed within 1 day. Therefore, methimazole treatment was again stopped and the symptoms disappeared.

Keywords: Methimazole, Arthralgia, Skin rash

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Fig. 1.

Punch biopsy of skin (right lower leg, ×200). Microscopic finding of skin biopsy shows mild superficial perivascular infiltrates and mild hyperkeratosis.

Fig. 2.

RI thyroid uptake. An RI thyroid scan reveal mild diffuse goiter with decreased uptake.

Fig. 3.

Ultrasonography of thyroid. A thyroid ultrasonography transverse view shows diffuse enlargement of both thyroid glands with heterogeneous low echogenicity.

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