title: [Pyoderma gangrenosum associated with anti-proteinase 3 antineutrophil cytoplasmic antibodies (PR3-ANCA) induced by propylthiouracil].
abstract: BACKGROUND
  Synthetic antithyroid drugs are often used in the treatment of hyperthyroidism, regardless of aetiology. They may cause various side effects, including the development of anti-neutrophil cytoplasmic antibodies (ANCA), ANCA-associated vasculitis, and neutrophilic dermatoses. Propylthiouracil (PTU) is the antithyroid drug most frequently implicated in ANCA-associated diseases specifically involving anti-myeloperoxidase ANCA (MPO-ANCA). To our knowledge, there are no clinical reports describing the association of pyoderma gangrenosum (PG) and anti-proteinase3-ANCA (PR3-ANCA) induced by PTU, with ANCA levels decreasing after antithyroid drug withdrawal.
  
  
  METHODS
  A 68-year-old woman was treated with propylthiouracil (PTU) for toxic multinodular goitre. She presented necrotic ulceration of the lower abdomen. The patient's history, physical examination, and bacteriological and histological samples led to a diagnosis of pyoderma gangrenosum. This pyoderma involved ANCA with antigenic specificity for proteinase 3. Withdrawal of PTU and a short course of corticosteroids and cyclosporine resulted in rapid and complete resolution of the pyoderma gangrenosum as well as a decrease in ANCA. No relapse was observed one year after cessation of treatment.
  
  
  CONCLUSIONS
  We report a case of PG associated with PR3-ANCA induced by PTU, without any demonstrable vasculitis.
authors.affiliation: Département de dermatologie, grand hôpital de Charleroi (GHDC), Grand'Rue 3, 6000 Charleroi, Belgique. Electronic address: alisoncoster@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Coster
authors.affiliation: Département d'anatomie pathologique, institut de pathologie et de génétique (IPG), 25, avenue Georges-Lemaître, 6041 Gosselies, Belgique.
authors.forename: J-L
authors.initials: JL
authors.lastname: Dargent
authors.affiliation: Département de médecine interne, grand hôpital de Charleroi (GHDC), Grand'Rue 3, 6000 Charleroi, Belgique.
authors.forename: N
authors.initials: N
authors.lastname: de Visscher
authors.affiliation: Département de médecine interne, grand hôpital de Charleroi (GHDC), Grand'Rue 3, 6000 Charleroi, Belgique.
authors.forename: P
authors.initials: P
authors.lastname: Levecque
authors.affiliation: Département de dermatologie, grand hôpital de Charleroi (GHDC), Grand'Rue 3, 6000 Charleroi, Belgique.
authors.forename: P-P
authors.initials: PP
authors.lastname: Roquet-Gravy
mesh_terms: D000005:Abdomen; D000368:Aged; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; D019268:Antibodies, Antineutrophil Cytoplasmic; D013956:Antithyroid Agents / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D016572:Cyclosporine / Q000627:therapeutic use*; D003879:Dermatologic Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D006980:Hyperthyroidism / Q000188:drug therapy; D011441:Propylthiouracil / Q000009:adverse effects*; D017511:Pyoderma Gangrenosum / Q000139:chemically induced*; D016896:Treatment Outcome
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D013956:Antithyroid Agents; D015415:Biomarkers; D003879:Dermatologic Agents; D005938:Glucocorticoids; D011441:Propylthiouracil; D016572:Cyclosporine
keywords: ANCA anti-protéinase 3 (PR3-ANCA); Anti-neutrophil cytoplasmic antibody (ANCA); Anticorps anti-cytoplasme des neutrophiles (ANCA); Propylthiouracil; Propylthiouracile; Proteinase3-ANCA (PR3-ANCA); Pyoderma gangrenosum