J Korean Endocr Soc.  2007 Feb;22(1):45-49. 10.3803/jkes.2007.22.1.45.

p-ANCA Positive Vasculitis after Propylthiouracil (PTU) Medication in a Patient with Graves' Disease

Affiliations
  • 1Kangnam St. Mary's hospital, Division of Rheumatology, Department of Internal Medicine, The Catholic University of Korea and Sacred Heart hospital, Korea.
  • 2Division of Rheumatology, Department of Internal Medicine, Hallym University, Korea.

Abstract

A 34-year old woman was admitted to our hospital complaining of fever and multiple palpable purpura. She presented with symmetrical, polymorphic, dark-violet and black colored, edematous, tender, necrotic ulcerations and palpable purpuric lesions on her upper and lower extremities and face, except for her trunk, after restarting PTU therapy for relapsing Graves' disease. Palpable purpura can have many causes, including infectious and autoimmune processes. A rare cause is drug-induced vasculitis, and this may result from the production of antineutrophil cytoplasmic antibodies (ANCAs) in response to a medication. The patient's PTU-induced vasculitis was diagnosed by skin biopsy, and biopsy displayed remarkable p-ANCA positivity. The skin lesions resolved immediately after discontinuation of the drug and steroid therapy. We report here on a case of PTU induced vasculitis in a woman with Graves' disease who presented with palpable purpuric lesions and myeloperoxidase ANCA positivity in the blood. We observed clinical resolution of her symptoms following withdrawal of the PTU.

Keyword

Antineutrophil cytoplasmic antibody (ANCA); Graves' disease; PTU-induced vasculitis

MeSH Terms

Adult
Antibodies, Antineutrophil Cytoplasmic*
Biopsy
Female
Fever
Graves Disease*
Humans
Lower Extremity
Peroxidase
Propylthiouracil*
Purpura
Skin
Ulcer
Vasculitis*
Antibodies, Antineutrophil Cytoplasmic
Peroxidase
Propylthiouracil

Figure

  • Fig. 1 Skin biopsy section showed hemorrhage, thrombi formation, findings of vasculitis, acute and chronic inflammation in the dermis and fibrinoid necrosis, RBC extravasation, and thrombi formation. (A: H&E. ×40, B: H&E. ×400)


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