Anti-thyroid Drug-Induced Antineutrophil Cytoplasmic Antibody (ANCA) Associated Vasculitis. A Case Report and Review of the Literature

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  • 抗甲状腺薬によるANCA関連血管炎：プロピルチオウラシル（PTU）による1例および既報44例の検討
  • コウコウジョウセンヤク ニ ヨル ANCA カンレン ケッカンエン : プロピルチオウラシル(PTU)ニ ヨル 1レイ オヨビ キホウ 44レイ ノ ケントウ

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A 48-year-old female patient with hyperthyroidism had been receiving propylthiouracil (PTU) for the last 13 years. She developed hemoptysis and dyspnea 4 years after the beginning of PTU therapy (300mg/day). She manifested hematuria, occult blood in stool and severe anemia. RA-test and anti-nuclear antibody (homogenous and speckled) were positive. Soon after, she developed sudden deafness. Episcleritis/scleritis had been present when she received PTU more than 150mg/day. She had received 300mg/day of PTU again for the previous 1.5years, and she developed fever of unknown origin, anemia, and intestinal bleeding. Hematuria was also recognized. Purpura and ecchymosis of lower extremities were significant. They showed leukocytoclastic vasculitis of arterioles, venules, capillaries, and small arteries. She complained of arthralgia and myalgia. Ten months later, she developed hemosputum and her MPO-ANCA was 406EU/ml. Withdrawal of PTU resolved all symptoms. Among the previously reported 45 cases of ANCA-associated vasculitis caused by anti-thyroid drugs, 44% manifested skin lesions. Most of the cases developed crescentic glomerulonephritis and/or pulmonary hemorrhage similar to microscopic polyangiitis. There are two types of vasculitis induced by PTU ; ANCA-associated vasculitis and immune complex-mediated cutaneous leukocytoclastic vasculitis. A common mechanism is speculated for the formation of ANCA and anti-nuclear antibody.

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