title: Concomitant drug- and infection-induced antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis with multispecific ANCA.
abstract: OBJECTIVE
  To report the first case of concomitant drug- and infection-induced antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) in a patient treated with propylthiouracil (PTU) and suffering from tuberculosis.
  A 28-year-old woman with PTU-treated hyperthyroidism presented with fever, purpura, pulmonary cavitations and ANCA to myeloperoxidase, bactericidal/permeability-increasing protein (BPI), proteinase-3 and elastase. Skin histopathology confirmed vasculitis. However, sputum examination revealed Mycobacterium tuberculosis. Remission was achieved after PTU withdrawal and treatment with antituberculosis drugs.
  
  
  CONCLUSIONS
  Our case confirmed that BPI-ANCA are elevated in active tuberculosis. Multispecific ANCA were helpful for the diagnosis of concomitant PTU- and M. tuberculosis-induced AAV.
authors.affiliation: Dermatology and Allergy and Clinical Immunology, Clinical Center of Serbia, and Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Milica
authors.initials: M
authors.lastname: Kontic
authors.forename: Sanja
authors.initials: S
authors.lastname: Radovanovic
authors.forename: Milos
authors.initials: M
authors.lastname: Nikolic
authors.forename: Branka
authors.initials: B
authors.lastname: Bonaci-Nikolic
mesh_terms: D000328:Adult; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000009:adverse effects* / Q000276:immunology*; D013956:Antithyroid Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006980:Hyperthyroidism / Q000188:drug therapy; D011441:Propylthiouracil / Q000009:adverse effects* / Q000627:therapeutic use; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy; D014657:Vasculitis / Q000139:chemically induced / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D013956:Antithyroid Agents; D000995:Antitubercular Agents; D011441:Propylthiouracil