title: Antineutrophil cytoplasmic antibody (ANCA)-positive cutaneous leucocytoclastic vasculitis associated with antithyroid therapy in Graves' disease.
abstract: Presented is a case of a 27-year-old male with Graves' disease on long-term propylthiouracil treatment who, when changed to carbimazole, rapidly developed a petechial and purpuric eruption on the legs, which subsequently flared on treatment with radioiodine. The clinical diagnosis of leucocytoclastic vasculitis was confirmed on skin biopsy. High-titre antineutrophil cytoplasmic antibodies in a perinuclear pattern (P-ANCA) were identified. No anti-myeloperoxidase activity was noted; therefore, the P-ANCA were classified in the atypical group. The target antigens, as determined by enzyme-linked immunosorbent assay, were lysozyme, lactoferrin and bactericidal/permeability increasing protein. Propylthiouracil and carbimazole are chemically related antithyroid drugs. There are reports of typical and atypical P-ANCA-positive cutaneous vasculitis due to propylthiouracil. Cutaneous vasculitis associated with atypical P-ANCA has not been noted previously to be temporally related to carbimazole use. The consideration of thionamides as possible aetiological agents in cases of P-ANCA-positive drug-induced vasculitis is suggested.
authors.affiliation: Department of Dermatology, Royal Brisbane Hospital, Queensland, Australia.
authors.forename: R M
authors.initials: RM
authors.lastname: Miller
authors.forename: J
authors.initials: J
authors.lastname: Savige
authors.forename: L
authors.initials: L
authors.lastname: Nassis
authors.forename: B I
authors.initials: BI
authors.lastname: Cominos
mesh_terms: D000328:Adult; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis*; D013956:Antithyroid Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001707:Biopsy, Needle; D002231:Carbimazole / Q000009:adverse effects* / Q000627:therapeutic use; D003937:Diagnosis, Differential; D003875:Drug Eruptions / Q000209:etiology / Q000473:pathology; D006111:Graves Disease / Q000188:drug therapy; D006801:Humans; D007866:Leg; D008297:Male; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000139:chemically induced* / Q000175:diagnosis*
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D013956:Antithyroid Agents; D002231:Carbimazole