J Rheum Dis.  2014 Jun;21(3):162-165. 10.4078/jrd.2014.21.3.162.

A Case of Propylthiouracil induced Antineutrophil Cytoplasmic Antibody Positive Pyoderma Gangrenosum

• Lee JY
• Lee JM
• Lee TH
• Jeong HJ
• Choi G
• Chae JN
• Kim JM
• Kim SH

• KMID: 2297530
• DOI: http://doi.org/10.4078/jrd.2014.21.3.162

Abstract

Pyoderma gangrenosum (PG) is a rare disease that causes chronic skin ulcers, and it has recently been known to be related to changes in the immune system such as dysfunction of neutrophils. Over 50% of patients with PG have an underlying systemic disease, and rarely are there various medicines causing the disease, including iodide, bromide, and isotretinoin. A 49-year-old man had recurrent skin ulcers in his lower extremities. He had a history of taking propylthiouracil (PTU) for 10 years as a treatment for Graves' disease. Here, we describe a case of PTU-induced ANCA positive PG in a patient with hyperthyroidism, who has been improved after the cessation of PTU.

Keyword

Pyoderma gangrenosum; Propylthiouracil; ANCA

MeSH Terms

Antibodies, Antineutrophil Cytoplasmic*
Graves Disease
Humans
Hyperthyroidism
Immune System
Isotretinoin
Lower Extremity
Middle Aged
Neutrophils
Propylthiouracil*
Pyoderma Gangrenosum*
Rare Diseases
Skin Ulcer
Antibodies, Antineutrophil Cytoplasmic
Isotretinoin
Propylthiouracil

Figure

• 

  Figure 1. (A) Initial presentation, painful central necrosis and ulcer on the medial aspect of the left mid calf had undermined violaceous borders. (B) Ten months after discontinuation of PTU, resolution of the ulcer was observed.

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  Figure 2. The skin biopsy from the border of the ulcer revealed massive inflammatory infiltrates with abscess (arrow) formation (A, H&E, ×40) and marked diffuse dermal neutrophilic infiltrate (B, H&E, ×400).

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