J Korean Endocr Soc.  2007 Jun;22(3):215-219. 10.3803/jkes.2007.22.3.215.

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

• Sun DS
• Kim DK
• Lee HJ
• Lee HY
• Kim DJ
• Kim ES
• Cho JH
• Ko SH
• Kim WO
• Kim CH
• Song KH
• Ahn YB

• KMID: 1512034
• DOI: http://doi.org/10.3803/jkes.2007.22.3.215

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.

Keyword

Antineutrophil cytoplasmic antibody (ANCA); Diffuse alveolar hemorrhage (DAH); Propylthiouracil (PTU)

MeSH Terms

Adrenal Cortex Hormones
Adult
Agranulocytosis
Antibodies, Antineutrophil Cytoplasmic*
Antithyroid Agents
Arthralgia
Autoimmune Diseases
Exanthema
Female
Fever
Graves Disease*
Hemoptysis
Hemorrhage*
Humans
Methimazole
Myeloblastin
Peroxidase
Propylthiouracil
Vasculitis
Adrenal Cortex Hormones
Antibodies, Antineutrophil Cytoplasmic
Antithyroid Agents
Methimazole
Myeloblastin
Peroxidase
Propylthiouracil

Figure

• 

  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.

• 

  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.

• 

  Fig. 3 Bronchoscopy. Showing normal findings.

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