title: [Case of myeloperoxidase-antineutrophil cytoplasmic antibody-associated pulmonary alveolar hemorrhage caused by propylthiouracil].
abstract: We reported the case of pulmonary alveolar hemorrhage caused by propylthiouracil (PTU) with severe respiratory failure and anemia, who improved with PTU discontinuance and steroid therapy. A 35-year-old woman presented with pyrexia, shortness of breath, and arthralgia. Her chest radiograph and CT showed diffuse ground-glass opacities, and her arterial blood gas analysis revealed severe respiratory failure. Laboratory results included a hemoglobin level of 5.2 g/dl, and a myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) level of 203 EU (normal range <9.0 EU). As bronchoalveolar lavage (BAL) fluid showed fresh blood-like fluid containing hemosiderin-laden macrophages, pulmonary alveolar hemorrhage was diagnosed. Since she had been taking PTU for 4 years, PTU was immediately discontinued. Steroid pulse therapy was performed, followed by oral prednisolone 30 mg per day, and her symptoms and chest radiograph findings rapidly improved. Based on the time-course changes, MPO-ANCA may have been involved in the development of pulmonary alveolar hemorrhage.
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University Hospital.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nakayama
authors.forename: Masashi
authors.initials: M
authors.lastname: Bando
authors.forename: Akira
authors.initials: A
authors.lastname: Kobayashi
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Hosono
authors.forename: Akihiro
authors.initials: A
authors.lastname: Tsujita
authors.forename: Hideaki
authors.initials: H
authors.lastname: Yamasawa
authors.forename: Shoji
authors.initials: S
authors.lastname: Ohno
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Sugiyama
mesh_terms: D000328:Adult; D019268:Antibodies, Antineutrophil Cytoplasmic; D013956:Antithyroid Agents / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D006980:Hyperthyroidism / Q000188:drug therapy; D008171:Lung Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D008775:Methylprednisolone; D009195:Peroxidase / Q000276:immunology*; D011239:Prednisolone / Q000008:administration & dosage; D011441:Propylthiouracil / Q000009:adverse effects*; D011650:Pulmonary Alveoli; D020551:Pulse Therapy, Drug; D012131:Respiratory Insufficiency / Q000188:drug therapy / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D013956:Antithyroid Agents; D011441:Propylthiouracil; D011239:Prednisolone; D009195:Peroxidase; D008775:Methylprednisolone