A fatal case of propylthiouracil-induced ANCA-associated vasculitis resulting in rapidly progressive glomerulonephritis, acute hepatic failure, and cerebral angiitis

Abstract

PTU can cause ANCAassociated vasculitis resulting in multiorgan failure. Plasmapheresis should be held for 3 days after rituximab infusion in order to allow maximum exposure. The second dose of rituximab may be given before the recommended 7-day interval in cases in which plasmapheresis is being performed to maximize therapeutic benefit.

Granulomatosis with polyangiitis: an unusual cause of acute liver injury

“…Drug therapy has been described as a cause of liver injury in vasculitis, either by the drug-inducing AAV, as with propylthiouracil,16 or through drug hepatotoxicity 17. Drug reaction was unlikely in our patient; he had taken methotrexate and hydroxychoroquine for more than 12 months prior to developing abnormal liver function tests, and initiation of treatment for vasculitis reversed hepatic injury.…”

Pauci‐immune glomerulonephritis in a captive chimpanzee (Pan troglodytes), and a review of spontaneous cases in animals

“…This animal was negative for ANCA antibodies; however, it is of importance to note that the ANCA antibody test has not been validated on non‐human species making this negative result not entirely reliable. Additionally, pauci‐immune‐type RPGN has been associated with certain drugs revealed to induce autoantibodies: propylthiouracil, methimazole, penicillamine, and allopurinol . To our knowledge, this chimpanzee was not exposed to any of these drugs.…”

“…The increase in severity and number of crescents in the glomeruli of the infarct‐like area compared to the rest of the kidney suggests a possible relationship between RPGN and ischemia. Currently, there are no publications of renal infarction‐related crescentic glomerulonephritis; however, there has been one report of RPGN development post‐renal ischemia‐reperfusion, and another report of a woman with a cerebral ischemic infarct and RPGN associated with chronic use of the drug propylthiouracil …”

“…Pauci‐immune‐type glomerulonephritis has been associated with systemic autoimmune diseases such as GPA (Wegener's granulomatosis), MPA, and eosinophilic GPA (EGPA, Churg‐Strauss syndrome) . The lack of evidence of systemic disease in the animal's history, and findings on gross and microscopic examination, decreases the likelihood that this case of pauci‐immune glomerulonephritis was associated with any of these systemic autoimmune diseases.…”

Propylthiouracil-Induced Anti-Neutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis Presenting with Multiple Sterile Abscesses, Mononeuritis Multiplex, and Splenic Vein Thrombosis: A Case Report and Literature Review

“…This disease usually presents in middle-aged females with a history of Graves’ disease that is being treated with PTU for varying periods [ 6 , 11 , 12 ]. Disease severity is variable, from mild systemic symptoms such as fever, fatigue, and arthralgias, to organ-threatening and life-threatening complications most commonly affecting the renal and pulmonary systems, including pauci-immune rapidly progressive glomerulonephritis, diffuse alveolar hemorrhage, and death [ 7 , 13 , 14 ]. With the above facts in mind, our case report is unique because the presentation of the disease was atypical; No similar cases were found in the literature review that was conducted and presented in this paper.…”