title: Carbimazole-induced lupus.
abstract: We describe the case of a 50-year-old lady admitted with a 3-week history of dyspnoea and left-sided pleuritic pain associated with pleural effusion. This common clinical picture nevertheless gave rise to a significant diagnostic challenge. The medical history included a diagnosis of thyrotoxicosis made 6 months previously that was being treated with carbimazole by her general practitioner. Key-investigation results were as follows: (1) pleural fluid was sterile and exudative, with no malignant cells, (2) erythrocyte sedimentation rate, C reactive protein and D-dimer were raised, (3) antinuclear antibody, anti-dsDNA and antihistone antibodies were newly positive, (4) imaging revealed a large left ventricular mass consistent with thrombus in the absence of evidence of a myocardial infarction. Based on the above investigations we hypothesised that carbimazole had induced systemic lupus erythematosus, manifesting as serositis resulting in an exudative pleural effusion and a proinflammatory/prothrombotic state. Carbimazole was stopped. The patient's pleural effusion completely resolved and she remains asymptomatic.
authors: Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK. i.haq@nhs.net
authors: Ihteshamul
authors: I
authors: Haq
authors: Michael D
authors: MD
authors: Sosin
authors: Simon
authors: S
authors: Wharton
authors: Anindya
authors: A
authors: Gupta
mesh_terms: D013956:Antithyroid Agents / Q000009:adverse effects*; D002231:Carbimazole / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000139:chemically induced*; D008875:Middle Aged; D013971:Thyrotoxicosis / Q000188:drug therapy
chemical_list: D013956:Antithyroid Agents; D002231:Carbimazole
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