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Propylthiouracil-Induced Antineutrophil Cytoplasmic Antibodies-Associated Vasculitis with Renal and Lung Involvement

Propylthiouracil (PTU)-induced antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) is a rare and heterogeneous disease. Moreover, optimal treatment is still lacking. We described the case of a 44-year-old lady with underlying Graves' disease who had cough, blood-streaked sp...

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Main Authors: Wong, Albert Hing, Wong, Wei-Kei, Looi, Lai-Meng, Ratnasingam, Jeyakantha, Lim, Soo-Kun
Format: Article
Published: S. Karger AG 2022
Online Access:http://eprints.um.edu.my/43734/
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85133023911&doi=10.1159%2f000525182&partnerID=40&md5=153e0b64c9f6bae42891e965c39a395c
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spelling my.um.eprints.437342023-10-24T02:56:33Z http://eprints.um.edu.my/43734/ Propylthiouracil-Induced Antineutrophil Cytoplasmic Antibodies-Associated Vasculitis with Renal and Lung Involvement Wong, Albert Hing Wong, Wei-Kei Looi, Lai-Meng Ratnasingam, Jeyakantha Lim, Soo-Kun Propylthiouracil (PTU)-induced antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) is a rare and heterogeneous disease. Moreover, optimal treatment is still lacking. We described the case of a 44-year-old lady with underlying Graves' disease who had cough, blood-streaked sputum, and impaired renal function. A strongly positive anti-myeloperoxidase antibody (>200 U/mL) along with pauci-immune glomerulonephritis and pulmonary hemorrhage resulted in the diagnosis of PTU-induced AAV, given that the patient had been on PTU for 3 years. PTU withdrawal, therapeutic plasma exchanges, and oral cyclophosphamide provided favorable clinical and biochemical outcomes. She remained well on azathioprine 50 mg daily as maintenance therapy and clinically euthyroid with carbimazole 2.5 mg daily. The effective treatment for drug-induced ANCA vasculitis remains controversial, but rapid withdrawal of the offending medication should be the mainstay of treatment. In severe drug-induced ANCA vasculitis with pulmonary hemorrhage and/or life-threatening organ involvement such as kidney failure requiring dialysis, therapeutic plasma exchange with immunosuppressants is often required. In this case, we have shown that patient achieved remission after therapeutic plasma exchange with cyclophosphamide in the acute stage of treatment and remained symptom-free with azathioprine in the maintenance phase of treatment for 24 months. © 2022 The Author(s). S. Karger AG 2022 Article NonPeerReviewed Wong, Albert Hing and Wong, Wei-Kei and Looi, Lai-Meng and Ratnasingam, Jeyakantha and Lim, Soo-Kun (2022) Propylthiouracil-Induced Antineutrophil Cytoplasmic Antibodies-Associated Vasculitis with Renal and Lung Involvement. Case Reports in Nephrology and Dialysis, 12 (2). 105 – 111. https://www.scopus.com/inward/record.uri?eid=2-s2.0-85133023911&doi=10.1159%2f000525182&partnerID=40&md5=153e0b64c9f6bae42891e965c39a395c
institution Universiti Malaya
building UM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaya
content_source UM Research Repository
url_provider http://eprints.um.edu.my/
description Propylthiouracil (PTU)-induced antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) is a rare and heterogeneous disease. Moreover, optimal treatment is still lacking. We described the case of a 44-year-old lady with underlying Graves' disease who had cough, blood-streaked sputum, and impaired renal function. A strongly positive anti-myeloperoxidase antibody (>200 U/mL) along with pauci-immune glomerulonephritis and pulmonary hemorrhage resulted in the diagnosis of PTU-induced AAV, given that the patient had been on PTU for 3 years. PTU withdrawal, therapeutic plasma exchanges, and oral cyclophosphamide provided favorable clinical and biochemical outcomes. She remained well on azathioprine 50 mg daily as maintenance therapy and clinically euthyroid with carbimazole 2.5 mg daily. The effective treatment for drug-induced ANCA vasculitis remains controversial, but rapid withdrawal of the offending medication should be the mainstay of treatment. In severe drug-induced ANCA vasculitis with pulmonary hemorrhage and/or life-threatening organ involvement such as kidney failure requiring dialysis, therapeutic plasma exchange with immunosuppressants is often required. In this case, we have shown that patient achieved remission after therapeutic plasma exchange with cyclophosphamide in the acute stage of treatment and remained symptom-free with azathioprine in the maintenance phase of treatment for 24 months. © 2022 The Author(s).
format Article
author Wong, Albert Hing
Wong, Wei-Kei
Looi, Lai-Meng
Ratnasingam, Jeyakantha
Lim, Soo-Kun
spellingShingle Wong, Albert Hing
Wong, Wei-Kei
Looi, Lai-Meng
Ratnasingam, Jeyakantha
Lim, Soo-Kun
Propylthiouracil-Induced Antineutrophil Cytoplasmic Antibodies-Associated Vasculitis with Renal and Lung Involvement
author_facet Wong, Albert Hing
Wong, Wei-Kei
Looi, Lai-Meng
Ratnasingam, Jeyakantha
Lim, Soo-Kun
author_sort Wong, Albert Hing
title Propylthiouracil-Induced Antineutrophil Cytoplasmic Antibodies-Associated Vasculitis with Renal and Lung Involvement
title_short Propylthiouracil-Induced Antineutrophil Cytoplasmic Antibodies-Associated Vasculitis with Renal and Lung Involvement
title_full Propylthiouracil-Induced Antineutrophil Cytoplasmic Antibodies-Associated Vasculitis with Renal and Lung Involvement
title_fullStr Propylthiouracil-Induced Antineutrophil Cytoplasmic Antibodies-Associated Vasculitis with Renal and Lung Involvement
title_full_unstemmed Propylthiouracil-Induced Antineutrophil Cytoplasmic Antibodies-Associated Vasculitis with Renal and Lung Involvement
title_sort propylthiouracil-induced antineutrophil cytoplasmic antibodies-associated vasculitis with renal and lung involvement
publisher S. Karger AG
publishDate 2022
url http://eprints.um.edu.my/43734/
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85133023911&doi=10.1159%2f000525182&partnerID=40&md5=153e0b64c9f6bae42891e965c39a395c
_version_ 1781704696517361664
score 13.211869

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