Antineutrophil cytoplasmic antibody (ANCA)-associated autoimmune diseases induced by antithyroid drugs: comparison with idiopathic ANCA vasculitides

Bonači-Nikolić, Branka; Nikolić, Miloš; Andrejević, Sladjana; Zorić, Svetlana; Bukilica, Mirjana

doi:10.1186/ar1789

Cited by 114 publications

(23 citation statements)

References 43 publications

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“…Treatment depends on the severity of the illness. Of top priority is discontinuing the PTU immediately after the diagnosis of PTU-induced AAV ( 8 , 23 , 24 ). Treatment with corticosteroids, immunosuppressive drugs (e.g., cyclophosphamide and azathioprine), or plasmapheresis should be reserved for patients with active and vital organ involvement such as pulmonary or renal vasculitis for improving organ function and preventing progression to severe and irreversible disease ( 23 , 25 ).…”

Section: Discussionmentioning

confidence: 99%

Propylthiouracil-Induced Vasculitis With Alveolar Hemorrhage Confirmed by Clinical, Laboratory, Computed Tomography, and Bronchoscopy Findings: A Case Report and Literature Review

Chen

Yang

Guo

et al. 2016

Iran Red Crescent Med J

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Introduction: 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. Case Presentation: 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.

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Section: Discussionmentioning

confidence: 99%

Propylthiouracil-Induced Vasculitis With Alveolar Hemorrhage Confirmed by Clinical, Laboratory, Computed Tomography, and Bronchoscopy Findings: A Case Report and Literature Review

Chen

Yang

Guo

et al. 2016

Iran Red Crescent Med J

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“…ANCA titers are also not helpful in this setting as they are usually not elevated in limited WG. An association between patients with hyperthyroidism treated with antithyroid medications and the development of ANCA associated vasculitis has been reported in the literature 7. The prevalence of the Grave’s disease and limited Wegener’s Granulomatosis occurring in the same patient is unknown.…”

Section: Discussionmentioning

confidence: 99%

Exophthalmos as a Presenting Manifestation of Limited Wegener's Granulomatosis in a Patient with Prior Graves' Disease

Bowers

Gupta

Patel

et al. 2009

Clinical Medicine: Case Reports

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Wegener’s granulomatosis is a granulomatous necrotizing vasculitis characterized by its predilection to affect the upper and lower respiratory tracts and kidneys. Ocular manifestations such as keratitis, conjunctivitis, scleritis, episcleritis, nasolacrimal duct obstruction, uveitis, retroorbital pseudotumor with proptosis retinal vessel occlusion, and optic neuritis have all been described. We present a case of limited Wegener’s granulomatosis presenting with proptosis.A 57 year old woman with a history of Graves’ disease 20 yrs ago, presented to her ophthalmologist with new onset of exophthalmos of right eye. An MRI of the brain and orbits revealed a soft tissue mass behind the right orbit. The biopsy of the mass revealed transmural inflammation with fibrinoid necrosis consistent with necrotizing vasculitis. She was diagnosed with Wegener’s granulomatosis limited to the eye and was treated with oral cyclophosphamide and prednisone followed by weekly methotrexate with good response.Though ocular manifestations of Wegener’s granulomatosis are well described, a review of the literature revealed that exophthalmos as the lone presenting manifestation is quite rare. Only two cases have been reported in the English literature since 1977. This case illustrates the importance of considering a diagnosis of limited Wegener’s granulomatosis presenting with proptosis of the orbit.

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“…Cutaneous lesions are the most frequent manifestations of PTU-induced AAV [8]. They vary from palpable purpura, vesicles and bullae to cutaneous necroses [8]. Our patient had typical clinical (arthralgia, fever, cutaneous vasculitis), laboratory (bicytopenia, low complement) and serological markers (high MPO-ANCA with low PR3-ANCA, elastase-ANCA, ANA and aCL) for PTU-induced AAV.…”

Section: Discussionmentioning

confidence: 99%

“…High MPO-ANCA, present in our patient, are the most specific serological markers for PTU-induced AAV [2,5]. On the other hand, asymmetric pulmonary infiltrates with cavitations and elevated BPI-ANCA were not typical of PTU-induced AAV [5,8]. BPI-ANCA are most frequently present in patients with tuberculosis or chronic pulmonary infections, especially with Pseudomonas aeruginosa [2,9].…”

Section: Discussionmentioning

confidence: 99%

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Concomitant Drug- and Infection-Induced Antineutrophil Cytoplasmic Autoantibody (ANCA)-Associated Vasculitis with Multispecific ANCA

et al. 2012

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Objective: To report the first case of concomitant drug- and infection-induced antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) in a patient treated with propylthiouracil (PTU) and suffering from tuberculosis. Presentation and Intervention: A 28-year-old woman with PTU-treated hyperthyroidism presented with fever, purpura, pulmonary cavitations and ANCA to myeloperoxidase, bactericidal/permeability-increasing protein (BPI), proteinase-3 and elastase. Skin histopathology confirmed vasculitis. However, sputum examination revealed Mycobacterium tuberculosis. Remission was achieved after PTU withdrawal and treatment with antituberculosis drugs. Conclusion: Our case confirmed that BPI-ANCA are elevated in active tuberculosis. Multispecific ANCA were helpful for the diagnosis of concomitant PTU- and M. tuberculosis-induced AAV.

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Antineutrophil cytoplasmic antibody (ANCA)-associated autoimmune diseases induced by antithyroid drugs: comparison with idiopathic ANCA vasculitides

Abstract: Clinical and serological profiles of idiopathic and drug-induced autoimmune diseases can be very similar. We compared data from idiopathic and antithyroid drug (ATD)-induced antineutrophil cytoplasmic antibody (ANCA)-positive patients.

Cited by 114 publications

References 43 publications

Propylthiouracil-Induced Vasculitis With Alveolar Hemorrhage Confirmed by Clinical, Laboratory, Computed Tomography, and Bronchoscopy Findings: A Case Report and Literature Review

Propylthiouracil-Induced Vasculitis With Alveolar Hemorrhage Confirmed by Clinical, Laboratory, Computed Tomography, and Bronchoscopy Findings: A Case Report and Literature Review

Exophthalmos as a Presenting Manifestation of Limited Wegener's Granulomatosis in a Patient with Prior Graves' Disease

Concomitant Drug- and Infection-Induced Antineutrophil Cytoplasmic Autoantibody (ANCA)-Associated Vasculitis with Multispecific ANCA

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