[Case of myeloperoxidase-antineutrophil cytoplasmic antibody-associated pulmonary alveolar hemorrhage caused by propylthiouracil].
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.
Nakayama
Masayuki
M
Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University Hospital.
Bando
Masashi
M
Kobayashi
Akira
A
Hosono
Tatsuya
T
Tsujita
Akihiro
A
Yamasawa
Hideaki
H
Ohno
Shoji
S
Sugiyama
Yukihiko
Y
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
D019268:Antibodies, Antineutrophil Cytoplasmic; D013956:Antithyroid Agents; D011441:Propylthiouracil; D011239:Prednisolone; D009195:Peroxidase; D008775:Methylprednisolone