Propylthiouracil induced ANCA-associated vasculitis in a 14-year-old girl.
BACKGROUND
Antineutrophil cytoplasmic antibodies (ANCAs) are the serologic hallmark of ANCA-associated primary small-vessel vasculitides (AAVs), but these antibodies have also been described in other autoimmune diseases such as inflammatory bowel diseases. Furthermore, different drugs are linked to the induction of ANCA, including propylthiouracil (PTU). However progression into clinical overt vasculitis is less common.


METHODS
We describe the case of a young girl with Graves' disease presenting with fatigue, fever, episcleritis and arthritis. The unexpected double myeloperoxidase/proteinase 3-ANCA positivity triggered a multidisciplinary diagnostic work-up and resulted in the diagnosis of a clinically overt PTU-induced AAV. After PTU-withdrawal and treatment with high-dose corticosteroids, a favorable clinical and biochemical evolution was obtained.


CONCLUSIONS
The use of PTU in the management of hyperthyroidism is not considered first-line treatment in Europe and is even less commonly used in children. Nevertheless, pediatricians should be aware of the possibility of PTU-induced AAV, especially in the presence of multiple ANCA reactivities. Therefore, the use of this drug should be weighed carefully in children.
V
V
Schamp
C
C
Verfaillie
C
C
Bonroy
J
J
Vande Walle
A
A
Raes
J
J
Dehoorne
D000293:Adolescent; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000097:blood / Q000139:chemically induced*; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D005260:Female; D006111:Graves Disease / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D011441:Propylthiouracil / Q000009:adverse effects* / Q000627:therapeutic use*
D019268:Antibodies, Antineutrophil Cytoplasmic; D011441:Propylthiouracil
Anti-neutrophil cytoplasmic antibodies,; Drug-induced,; Graves’ disease,; Propylthiouracil,; Small vessel vasculitis