A fatal case of propylthiouracil-induced ANCA-positive vasculitis.
A 60-year-old man with a history of Graves' disease, treated with propylthiouracil (PTU), presented with a rash, pancytopenia, and lymphadenopathy. The patient subsequently developed acute renal failure and diffuse alveolar hemorrhage. Despite discontinuation of PTU and aggressive therapy including high-dose steroids, cyclophosphamide, and plasma exchange, the patient died. PTU-induced antineutrophilic cytoplasmic antibody (ANCA)-positive vasculitis has been well described in the literature. Patients with this condition are almost always positive for pANCA or anti-myeloperoxidase (MPO). Patients can have varying presentations, and symptoms usually resolve with discontinuation of the drug. Some patients, however, require high-dose steroids, immunosuppressives, or plasmapheresis. Rarely, fatalities can occur from this condition. The mechanism of PTU-induced vasculitis is not well understood.
Batchelor
Nick
N
Department of Medicine, Walter Reed Army Medical Center, Washington, DC; Email: nicholas.batchelor@na.amedd.army.mil.
Holley
Aaron
A
D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D011441:Propylthiouracil / Q000009:adverse effects*; D014657:Vasculitis / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis*
D019268:Antibodies, Antineutrophil Cytoplasmic; D011441:Propylthiouracil