Central nervous system vasculitis caused by propylthiouracil therapy: a case report and literature review.
Antineutrophil cytoplasmic antibodies (ANCA) are associated with vasculitis, including vasculitis induced by drugs such as the thionamides. The affected organ systems in thionamide-induced vasculitis have been primarily renal, musculoskeletal, and dermatologic. We describe the first case of thionamide-induced central nervous system vasculitis presenting as confusion, with complete resolution after discontinuation of propylthiouracil. We review the literature and summarize 42 additional cases of thionamide-induced ANCA-positive vasculitis since 1992. Propylthiouracil was responsible in 93% of cases and the predominant ANCA pattern on immunofluorescent staining was perinuclear (p-ANCA). Clinical improvement occurred after drug discontinuation in 93%, steroid therapy was used in some cases. The mean duration of treatment with thionamides was 35 months prior to presentation. Long-term medical treatment with thionamides for hyperthyroidism may increase the risk of this severe side effect.
Vanek
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Oregon Health and Science University, Divison of Endocrinology, Diabetes, and Clinical Nutrition, Portland, OR 97239-3098, USA.
Samuels
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MH
D002493:Central Nervous System Diseases / Q000139:chemically induced*; D003221:Confusion / Q000139:chemically induced; D005260:Female; D006111:Graves Disease / Q000188:drug therapy; D006801:Humans; D008875:Middle Aged; D011441:Propylthiouracil / Q000009:adverse effects* / Q000627:therapeutic use; D014657:Vasculitis / Q000139:chemically induced*
D011441:Propylthiouracil