title: Development of anti-neutrophil cytoplasmic antibody-associated vasculitis in a patient with Graves' disease independent of anti-thyroid drug therapy.
abstract: Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) in patients with Graves' disease (GD) is linked with the use of anti-thyroid drugs (ATDs). We report the co-occurrence of AAV and GD in a patient that was independent of ATD therapy. A 38-year-old white male presented with systemic symptoms, palpitations, tremors, purpuric skin lesions, and digital pain. Physical examination and biological tests confirmed GD. He quickly developed multiple digital gangrenes and testicular pain/mass. Skin and testicular biopsies showed granulomatous vasculitis of the small- and medium-sized vessels, while his serum contained anti-proteinase-3 antibody.
authors.affiliation: Division of Rheumatology, University of Arkansas for Medical Sciences, 4301 West Markham Street, #509, Little Rock, AR 72205, USA. nakhan@uams.edu
authors.forename: Nasim Ahmed
authors.initials: NA
authors.lastname: Khan
authors.forename: Manisha
authors.initials: M
authors.lastname: Singh
mesh_terms: D000328:Adult; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000209:etiology / Q000473:pathology*; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000276:immunology; D013956:Antithyroid Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001379:Azathioprine / Q000627:therapeutic use; D015415:Biomarkers; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000627:therapeutic use; D006111:Graves Disease / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D053146:Myeloblastin / Q000276:immunology; D011441:Propylthiouracil / Q000009:adverse effects / Q000627:therapeutic use*; D012074:Remission Induction; D012867:Skin / Q000098:blood supply / Q000473:pathology; D013737:Testis / Q000098:blood supply / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D013956:Antithyroid Agents; D015415:Biomarkers; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011441:Propylthiouracil; D053146:Myeloblastin; D001379:Azathioprine; D008775:Methylprednisolone