Ewha Med J.  2010 Sep;33(2):109-113. 10.12771/emj.2010.33.2.109.

Propylthiouracil-Induced ANCA-Positive Diffuse Alveolar Hemorrhage in a Patient with Thyroid Storm

• Kim SH
• Song EM
• Beak DH
• Oh HJ
• Kim HK
• Choi MY
• Kwon KJ
• Kang HW
• Kim SW
• Shim U
• Sung YA
• Hong YS

• KMID: 2283948
• DOI: http://doi.org/10.12771/emj.2010.33.2.109

Abstract

Propylthiouracil(PTU) is a commonly used antithyroid drug in the management of hyperthyroidism. However, it is associated with a variety of side effects. Antineutrophil cytoplasmic antibody( ANCA)-positive vasculitis is an extremely rare side effect of PTU. We report a case of a patient with diffuse pulmonary hemorrhage while being treated with PTU. A 28-year-old woman was admitted due to fever and abdominal pain. She was diagnosed as Graves' disease 4 years before the admission, and was taking PTU intermittently. Thyroid storm was suspected and we treated her with PTU, hydrocortisone, lugol solution and propranolol. However, coughing was aggravated, with chest X-ray and computed tomography revealing diffuse alveolar hemorrhage. Perinuclear-ANCA was positive. After discontinuation of PTU, all symptoms resolved. In conclusion, ANCA-positive diffuse alveolar hemorrhage is a rare but a potential side-effect of PTU. Therefore, early awareness of this complication is important.

Keyword

Antineutrophil cytoplasmic antibody; Propylthiouracil; Thyroid storm; Diffuse alveolar hemorrhage

MeSH Terms

Abdominal Pain
Adult
Antibodies, Antineutrophil Cytoplasmic
Cough
Cytoplasm
Female
Fever
Graves Disease
Hemorrhage*
Humans
Hydrocortisone
Hyperthyroidism
Propranolol
Propylthiouracil
Thorax
Thyroid Crisis*
Vasculitis
Antibodies, Antineutrophil Cytoplasmic
Hydrocortisone
Propranolol
Propylthiouracil