Central nervous system vasculitis after starting methimazole in a woman with Graves' disease.
BACKGROUND
Graves' disease (GD), a prototypical autoimmune disorder, is associated with other autoimmune diseases, including vasculitis. Antithyroid drugs, despite their postulated immunosuppressive effects, may cause several autoimmune disorders. Here we describe the first patient with central nervous system (CNS) vasculitis that developed shortly after the start of methimazole (MMI) treatment for GD.


METHODS
CNS vasculitis was suspected on the basis of the clinical features and neurologic examination, showing a reinforcement of deep reflexes, especially of the left knee and Achilles reflexes. The diagnosis was confirmed by a brain magnetic resonance imaging (MRI), which showed some hyperintensive spots in the subcortical substantia alba and in the parietal area bilaterally, and by a single-photon emission computed tomography (SPECT) imaging, which showed a nonhomogenous distribution of the blood flow in the brain, with a reduced perfusion on the left side of the frontotemporal and parietal regions, and on the right side of the frontotemporal area. MMI was stopped before total thyroidectomy, and symptoms resolved in the next 5 weeks. Six months after MMI was stopped, the brain MRI and SPECT had become normal.


CONCLUSIONS
To our knowledge, this is the first report of CNS vasculitis related to MMI therapy.
Tripodi
Pier Francesco
PF
Department of Internal Medicine, University of Messina, Messina, Italy.
Ruggeri
Rosaria M
RM
Campennì
Alfredo
A
Cucinotta
Mariapaola
M
Mirto
Angela
A
Lo Gullo
Renato
R
Baldari
Sergio
S
Trimarchi
Francesco
F
Cucinotta
Domenico
D
Russo
Giuseppina T
GT
D000328:Adult; D013956:Antithyroid Agents / Q000009:adverse effects*; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006111:Graves Disease / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008713:Methimazole / Q000009:adverse effects*; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D020293:Vasculitis, Central Nervous System / Q000139:chemically induced*
D013956:Antithyroid Agents; D007166:Immunosuppressive Agents; D019275:Radiopharmaceuticals; D008713:Methimazole