Carbimazole-induced, ANCA-associated, crescentic glomerulonephritis: case report and literature review.
Anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis is a rare complication of antithyroid drug use that was first described with propylthiouracil. We describe an ANCA-associated rapidly progressive glomerulonephritis in a patient treated with carbimazole during 6 months for Graves disease that resulted in end-stage renal disease. A 66-year-old man treated with carbimazole for Graves disease was admitted for macroscopic hematuria and edema of the lower extremities. Laboratory work-up showed elevated serum creatinine (435 μmol/L), mixed hematuria, nephrotic range proteinuria, and a low positive c-ANCA titer with proteinase-3 specificity. Renal biopsy showed necrotizing, crescentic, pauci-immune glomerulonephritis. Carbimazole was discontinued and hemodialysis was initiated as well as high-dose glucocorticoids and pulses of intravenous cyclophosphamide. Despite immunosuppressive treatment, the patient remained dialysis-dependent at 6 months after diagnosis. Graves disease remained in remission after carbimazole withdrawal. ANCA-associated vasculitis manifesting as glomerulonephritis is a potential adverse effect of all antithyroid drugs. Although prognosis is usually good, end-stage renal disease may ensue in rare cases. Physicians should have a high index of suspicion in patients receiving antithyroid drugs who present with symptoms or signs suggestive of progressive renal disease.
Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland. thomas.mavrakanas@hcuge.ch
Thomas A
TA
Mavrakanas
Yassine
Y
Bouatou
Caroline
C
Samer
Sophie
S
de Seigneux
Patrick
P
Meyer
D000368:Aged; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000139:chemically induced* / Q000150:complications; D013956:Antithyroid Agents / Q000009:adverse effects*; D002231:Carbimazole / Q000009:adverse effects*; D005921:Glomerulonephritis / Q000209:etiology*; D006111:Graves Disease / Q000188:drug therapy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology; D008297:Male
D013956:Antithyroid Agents; D002231:Carbimazole