Carbimazole Induced Pleural Effusion: A Case Report

Abstract

Objective. To describe a patient with unilateral exudative pleural effusion that developed after commencement of carbimazole. Methods. We describe the presentation and clinical journey of an elderly woman who presented to the chest physicians initially with pleural effusion but was followed up by the endocrinology team. Result. The patient was a 77-year-old Caucasian woman who presented with symptoms of breathlessness and a confirmed unilateral pleural effusion while being on treatment for thyrotoxicosis. Her symptoms needed recurrent hospital admission for investigations and drainage, but no potential cause was identified after extensive investigations. A drug-induced exudative effusion consequent to carbimazole intake was diagnosed as discontinuation of the drug lead to complete resolution of the effusion with no recurrence. Conclusion. Physicians and Endocrinologist must bear in mind that this potentially rare complication of carbimazole while treating patients of thyrotoxicosis as appearance of similar features in their patients while being on carbimazole should lead to the discontinuation of the drug, and alternative treatment strategy should be considered.

Carbimazole-induced exudative pleural effusions

“…As for the timing of such adverse events, carbimazole induced a pleural effusion after 6 months of high dose treatment (40 mg daily) in one case5 and after 3 months of treatment at a lower dose (20 mg daily) in another patient 6. Our patient presented with bilateral pleural effusions 27 months into his carbimazole therapy.…”

“…Pulmonary capillaritis with associated intra-alveolar haemorrhage has also been reported with methimazole 4. However, to our knowledge, carbimazole-induced pleural effusions have been reported in only two patients 5 6. We report a case of carbimazole-induced exudative bilateral pleural effusions in a middle-aged Caucasian man.…”

“…Reports of carbimazole-induced/carbimazole-associated ANCA-negative vasculitis/serositis are few and sparse in the medical literature. One such case involved an elderly woman with a unilateral exudative pleural effusion, whose vasculitic screen was negative 6. Additionally, a 50-year-old woman has been reported to develop carbimazole-induced lupus complicated by bilateral exudative pleural effusions 5.…”

Carbimazole-induced lupus

“…Of these, only one case report described a carbimazole-induced exudative pleural effusion 16. In that report a 77-year-old patient who presented with breathlessness was found to have atrial fibrillation, pulmonary embolus, congestive cardiac failure and new onset hyperthyroidism secondary to multinodular goitre.…”

Non-Anti-Neutrophil Anti-Cytoplasmic Antibodies Associated Methimazole-Induced Nephritis: Case and Review of Literature

“…In addition, our patient's pericardial effusion may also be secondary to drug-induced vasculitis. There have been five cases of pleural effusion induced by anti-thyroid drugs, two with PTU [17,18] and three with carbimazole [19][20][21], that have been reported in the literature. It is unknown whether there were eosinophils in his pleural effusions, which if present, would be more evidence for a potential drug cause.…”