Propylthiouracil-induced sensorineural hearing loss associated with antineutrophil cytoplasmic antibodies.
OBJECTIVE
To report the case of a young woman with Graves' disease in whom ototoxicity developed because of propylthiouracil (PTU)-induced antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis.


METHODS
We present the clinical findings, pertinent laboratory data, and follow-up course of a patient with Graves' disease and bilateral sensorineural hearing loss. We also provide a literature review regarding thionamide-induced ANCA-associated vasculitis.


RESULTS
In a 22-year-old Thai woman with Graves' disease, tinnitus, hearing impairment in the left ear (with progression to the right ear), and vertigo developed after 3 years of therapy with PTU. Audiograms showed bilateral sensorineural hearing loss with cochlear lesions. She also had low-grade fever, intermittent chronic abdominal pain, weight loss, polyarthralgia, and conjunctivitis. An indirect immunofluorescence test for ANCA was positive. The hearing impairment and tinnitus were gradually reduced after PTU withdrawal and corticosteroid and azathioprine treatment. Definitive therapy by subtotal thyroidectomy was subsequently performed and yielded good results.


CONCLUSIONS
This rare case of PTU-induced ANCA-associated vasculitis manifested with ototoxicity in combination with systemic involvement.
Thamprajamchit
Sriurai
S
Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Jariengprasert
Chanchai
C
Rajatanavin
Rajata
R
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000276:immunology*; D013956:Antithyroid Agents / Q000009:adverse effects*; D001299:Audiometry; D001379:Azathioprine / Q000627:therapeutic use; D005260:Female; D006111:Graves Disease / Q000188:drug therapy; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D011441:Propylthiouracil / Q000009:adverse effects*; D013965:Thyroidectomy; D016896:Treatment Outcome; D014657:Vasculitis / Q000209:etiology* / Q000628:therapy
D000305:Adrenal Cortex Hormones; D019268:Antibodies, Antineutrophil Cytoplasmic; D013956:Antithyroid Agents; D007166:Immunosuppressive Agents; D011441:Propylthiouracil; D001379:Azathioprine