title: Propylthiouracil-Induced Vasculitis With Alveolar Hemorrhage Confirmed by Clinical, Laboratory, Computed Tomography, and Bronchoscopy Findings: A Case Report and Literature Review.
abstract: BACKGROUND
  Propylthiouracil (PTU) is commonly used to treat hyperthyroidism and can induce antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Although this is a rare side effect, ANCA-associated vasculitis can progress to severe disease if its diagnosis and treatment are delayed, leading to a poor prognosis.
  
  
  METHODS
  A 43-year-old woman with Graves' disease developed pulmonary vasculitis and diffuse alveolar hemorrhage (DAH) associated with ANCA against myeloperoxidase and proteinase-3 that was confirmed by computed tomography (CT) and bronchoscopy and treated with PTU. The symptoms and signs of alveolar hemorrhage were rapidly resolved after PTU withdrawal and treatment with corticosteroids. After 6 months of follow-up, the patient maintained complete ANCA-negative clinical remission status, as confirmed by normal CT and bronchoscopy findings. To our knowledge, this is the first documented case of bronchoscopic comparison of PTU-induced DAH before and after steroid treatment.
  
  
  CONCLUSIONS
  Patients treated with PTU should be closely monitored and followed up, even if the drug has been used for several years. When patients develop progressive dyspnea with alveolar opacities on chest imaging that cannot be explained otherwise, alveolar hemorrhage should be an important differential diagnosis while investigating the case. Early diagnosis and prompt discontinuation of the PTU treatment are essential for improving patient outcomes.
authors.affiliation: Department of Radiologic Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Xiaoqing
authors.initials: X
authors.lastname: Yang
authors.affiliation: Department of Surgery, Taian Second Chinese Medicine Hospital, Taian, Shandong, China.
authors.forename: Shihai
authors.initials: S
authors.lastname: Sun
authors.affiliation: Department of Rheumatologic Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Weina
authors.initials: W
authors.lastname: Guo
authors.affiliation: Department of Radiologic Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Xiaosheng
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Radiologic Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Internal Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Zhongliang
authors.initials: Z
authors.lastname: Guo
authors.affiliation: Department of Rheumatologic Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Han
authors.affiliation: Department of Rheumatologic Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Li
keywords: Antineutrophil Cytoplasmic Antibody (ANCA); Graves’ Disease; Thyroid Disease; Vasculitis