title: Propylthiouracil-induced ANCA-positive erythema nodosum treated with thalidomide.
abstract: BACKGROUND
  Propylthiouracil (PTU), one of the mainstays of antithyroid therapy drugs, can lead to antineutrophil cytoplasmic antibody (ANCA) positivity and skin lesions. PTU-induced ANCA-positive vasculitis is rare and even more rare is erythema nodosum.
  
  
  OBJECTIVE
  To report a case of a 57-year-old woman with hyperthyroidism who developed myeloperoxidase (MPO)-ANCA erythema nodosum after PTU treatment for 11 months.
  
  
  METHODS
  Skin biopsy demonstrated septal panniculitis without vasculitis. PTU-induced ANCA-positive erythema nodosum was made.
  
  
  RESULTS
  With discontinuation of PTU and initiation of thalidomide, skin lesions resolved completely in three weeks, and after three months, the titers of MPO-ANCA and perinuclear-ANCA (p-ANCA) had decreased remarkably. At 14-month follow-up, the patient was asymptomatic, but low levels of ANCA titers persisted.
  
  
  CONCLUSIONS
  This report indicated that ANCA positive erythema nodosum could develop following PTU treatment. Thalidomide has been proven to be helpful and averted the adverse effects from systemic corticosteroids and other immunosuppressive drugs in this patient.
authors.affiliation: Department of Dermatology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University Shanghai, China.
authors.forename: Pengjie
authors.initials: P
authors.lastname: Wan
authors.forename: Xiaoqing
authors.initials: X
authors.lastname: Zhao
authors.forename: Ranganna Y P
authors.initials: RY
authors.lastname: Hunasehally
authors.forename: Ruofei
authors.initials: R
authors.lastname: Shi
authors.forename: Jie
authors.initials: J
authors.lastname: Zheng
mesh_terms: D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis*; D013956:Antithyroid Agents / Q000009:adverse effects* / Q000627:therapeutic use; D004893:Erythema Nodosum / Q000139:chemically induced* / Q000188:drug therapy* / Q000276:immunology; D005260:Female; D006801:Humans; D006980:Hyperthyroidism / Q000188:drug therapy; D007155:Immunologic Factors / Q000627:therapeutic use*; D008875:Middle Aged; D011441:Propylthiouracil / Q000009:adverse effects* / Q000627:therapeutic use; D013792:Thalidomide / Q000627:therapeutic use*
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D013956:Antithyroid Agents; D007155:Immunologic Factors; D013792:Thalidomide; D011441:Propylthiouracil