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

Abstract

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.

An Unusual Presentation of Propylthiouracil-Induced Immunoglobulin A Vasculitis With Positive Anti-proteinase-3 and Anti-myeloperoxidase Antibodies

“…Regarding PTU-induced ANCA vasculitis, the presence of a higher level of anti-MPO antibodies compared to anti-PR3 antibodies has been the more common presentation of this adverse reaction. However, this patient displayed higher levels of anti-PR3 antibodies [ 11 ]. This differentiates our case and provides insight into a unique presentation, further emphasizing the challenges in diagnosis and treatment.…”

Hepatitis B Virus-associated Vasculitis: Multiple Cavitary Masses in the Lung Mimicking Granulomatous Polyangiitis

“…According to the literature on HBV-associated vasculitis, HBV-PAN is the major presentation, and the lung is usually spared (1,7). There are various case reports of other exceptional presentations, including cryoglobulinemic vasculitis, ANCA-associated vasculitis, and alveolar hemorrhaging (3-5,16). This might suggest heterogeneity in HBV-associated vasculitis.…”

Propylthiouracil-induced ANCA-positive vasculitis in Graves’ disease

“…A biopsy of affected tissue may be necessary to confirm the diagnosis of vasculitis. Differential diagnosis should be made with other autoimmune diseases, infections, and malignancies (5).…”