Tuberc Respir Dis.  2012 Jan;72(1):93-97.

A Case of Diffuse Alveolar Hemorrhage with Glomerulonephritis after Propylthiouracil Treatment

• Lee JH
• Kim MS
• Lee JG
• Kim DS
• Yang HJ
• Kang KW

Abstract

Propylthiouracil (PTU) is one of the most common drugs used in the treatment of Graves' disease. There are a number of side effects found with PTU use including fever, rash, arthralgia, and flu-like symptoms. Recently antineutrophil cytoplasmic antibodies (ANCA) positive vasculitis after PTU treatment was reported as a rare side effect, which can cause diffuse alveolar hemorrhage and glomerulonephritis. A 45-year-old woman with Graves' disease had been treated with PTU for five months, complained of hemoptysis due to pulmonary alveolar hemorrhage causing anemia, and also had hematuria. Simple chest X-ray and HRCT showed bilateral consolidation and bronchoalveolar lavage fluid revealed alveolar hemorrhage. A serologic test was positive for ANCA against myeloperoxidase and proteinase-3. Such findings suggested that the presence of PTU induced ANCA positive vasculitis. Cessation of PTU and the administration of high dose steroids improved the clinical manifestation, radiologic and serologic findings. We observed ANCA titer serially for 6 years. During the follow up period, ANCA titer decreased slowly and stayed within the acceptable upper normal limit.

Keyword

Propylthiouracil; Antibodies, Antineutrophil Cytoplasmic; Hemoptysis

MeSH Terms

Anemia
Antibodies, Antineutrophil Cytoplasmic
Arthralgia
Bronchoalveolar Lavage Fluid
Exanthema
Female
Fever
Follow-Up Studies
Glomerulonephritis
Graves Disease
Hematuria
Hemoptysis
Hemorrhage
Humans
Middle Aged
Peroxidase
Propylthiouracil
Serologic Tests
Steroids
Thorax
Vasculitis
Antibodies, Antineutrophil Cytoplasmic
Peroxidase
Propylthiouracil
Steroids

Figure

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  Figure 1 Initial Chest X-ray showing diffuse infiltration in both lung fields.

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  Figure 2 Initial chest CT revealed (A) diffuse consolidation and air-bronchogram in the dependent portion of both upper lungs, and (B) diffuse consolidation and ground glass attenuation in both low lungs. CT: computed tomography.

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  Figure 3 (A) Bronchoscopic finding demonstrated diffuse hemorrhage at the trachea and both main bronchi. (B) Bronchoalvelar lavage fluid analysis found that pinkish blood was retrieved from the right middle lobe.

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  Figure 4 Follow up chest X-ray indicated resolution of previous infiltration.

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  Figure 5 Serial change of serum levels of Anti-MPO Ab and Anti-PR3 Ab titers.

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