PTU-associated cutaneous vasculitis with ANCA anti-MPO and anti-PR3 antibodies.
A 36-year-old woman presented at our clinic with symmetrical, tender, palpable purpuric lesions on her lower legs and buttocks after restarting PTU therapy for relapsing Graves' disease. PTU-induced vasculitis was diagnosed with remarkable ANCA anti-MPO and anti-PR3 antibody positivity. The purpuric skin lesions resolved immediately after discontinuation of the drug and the ANCA titres lowered. In the presence of activated neutrophils, PTU could induce a high cytotoxity and injure the vessel walls. Treatment of choice is discontinuation of the drug. Sometimes more aggressive therapy as cyclophosphamide or plasmapheresis is warranted.
Jacobs
E M G
EM
Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands. E. Jacobs@aig.umcn.nl
Hartkamp
A
A
Kaasjager
H A H
HA
D000328:Adult; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D001706:Biopsy; D005260:Female; D006111:Graves Disease / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D053146:Myeloblastin; D011441:Propylthiouracil / Q000009:adverse effects*; D011693:Purpura / Q000139:chemically induced / Q000175:diagnosis; D012697:Serine Endopeptidases / Q000276:immunology*; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000139:chemically induced* / Q000276:immunology*
D019268:Antibodies, Antineutrophil Cytoplasmic; D011441:Propylthiouracil; D012697:Serine Endopeptidases; D053146:Myeloblastin