title: Propylthiouracil-induced lupus, antiphospholipid syndrome, and stroke in a patient with Graves hyperthyroidism.
abstract: OBJECTIVE
  To describe a case of propylthiouracil-induced lupus, complicated with antiphospholipid syndrome and acute ischemic stroke.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  A 27-year-old man with a diagnosis of Graves disease developed multiple ischemic strokes 2 weeks after starting treatment with propylthiouracil. Thyrotoxicosis and abnormal hypercoagulable and rheumatological profiles were remarkable, with prolonged partial thromboplastin time, elevated anticardiolipin antibody level, and positive antinuclear antibody, lupus anticoagulant, Sjögren antibody, and anti-double-stranded DNA antibody test results, which were more than 8-fold greater than normal values. No clinical manifestations of systemic lupus erythematosus were present.
  
  
  METHODS
  Discontinuation of propylthiouracil and treatment with radioactive iodine.
  
  
  RESULTS
  Hyperthyroidism resolved and anti-double-stranded DNA antibodies returned to normal levels. Eventually, antiphospholipid syndrome was diagnosed. He was treated with oral anticoagulation and remained asymptomatic for 1 year of follow-up.
  
  
  CONCLUSIONS
  In this young man with Graves hyperthyroidism, treatment with propylthiouracil was associated with transient autoimmune reactions suggestive of drug-induced lupus, antiphospholipid syndrome, and acute ischemic stroke.
authors.affiliation: Department of Neurology, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA.
authors.forename: Gustavo A
authors.initials: GA
authors.lastname: Ortiz
authors.forename: Violet
authors.initials: V
authors.lastname: Lagari-Libhaber
authors.forename: Luz Marina
authors.initials: LM
authors.lastname: Prieto-Sanchez
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
mesh_terms: D000328:Adult; D016736:Antiphospholipid Syndrome / Q000139:chemically induced*; D013956:Antithyroid Agents / Q000009:adverse effects*; D002545:Brain Ischemia / Q000139:chemically induced*; D005500:Follow-Up Studies; D006111:Graves Disease / Q000188:drug therapy / Q000532:radiotherapy; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000139:chemically induced; D008297:Male; D011441:Propylthiouracil / Q000009:adverse effects* / Q000627:therapeutic use; D020521:Stroke / Q000139:chemically induced*
chemical_list: D013956:Antithyroid Agents; D011441:Propylthiouracil