Propylthiouracil-induced ANCA-associated vasculitis and agranulocytosis in a patient with Graves' disease

Nasal Septal Perforation in Propylthiouracil-Induced Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis

Case Reports in Rheumatology ◽

10.1155/2018/8192021 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Yusho Ishii ◽

Tsuyoshi Shirai ◽

Yousuke Hoshi ◽

Yoko Fujita ◽

Yuko Shirota ◽

...

Keyword(s):

Nasal Septum ◽

Rare Case ◽

Inflammatory Cells ◽

Graves Disease ◽

Septal Perforation ◽

Drug Induced ◽

Nasal Septal Perforation ◽

Anca Associated Vasculitis

Here, we present the case of a 29-year-old woman with nasal septal perforation and positive myeloperoxidase- (MPO-) anti-neutrophil cytoplasmic antibody (ANCA). She had been diagnosed with Graves’ disease and had been treated with propylthiouracil (PTU) for 14 months. A biopsy of the nasal septum revealed an infiltration of inflammatory cells, with no evidence of malignancy or granulomatous change. Because of the use of PTU, destructive nasal lesion, and positive MPO-ANCA, she was diagnosed with drug-induced ANCA-associated vasculitis (AAV) and was treated with prednisolone and methotrexate after the cessation of PTU. Although PTU is known to be the medicine that induces drug-induced AAV, the manifestation of nasal septal perforation in drug-induced AAV is poorly identified. This is the rare case of drug-induced AAV which manifested only nasal septal perforation.

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Propylthiouracil-induced antineutrophil cytoplasmic antibody-associated vasculitis and agranulocytosis in a patient with Graves’ disease

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-19-0135 ◽

2020 ◽

Vol 2020 ◽

Cited By ~ 1

Author(s):

Maria Tomkins ◽

Roxana Maria Tudor ◽

Diarmuid Smith ◽

Amar Agha

Keyword(s):

Adverse Effect ◽

Immunosuppressive Therapy ◽

Antithyroid Drug ◽

Antineutrophil Cytoplasmic Antibody ◽

Organ Damage ◽

Graves Disease ◽

List Type ◽

Drug Induced ◽

End Organ Damage ◽

Anca Associated Vasculitis

Summary This case is the first to describe a patient who experienced concomitant agranulocytosis and anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis as an adverse effect of propylthiouracil treatment for Graves’ disease. A 42-year-old female with Graves’ disease presented to the emergency department (ED) with a 2-week history of fevers, night sweats, transient lower limb rash, arthralgia, myalgia and fatigue. She had been taking propylthiouracil for 18 months prior to presentation. On admission, agranulocytosis was evident with a neutrophil count of 0.36 × 109/L and immediately propylthiouracil was stopped. There was no evidence of active infection and the patient was treated with broad-spectrum antibodies and one dose of granulocyte colony-stimulation factor, resulting in a satisfactory response. On further investigation, ANCAs were positive with dual positivity for proteinase 3 and myeloperoxidase. There was no evidence of end-organ damage secondary to vasculitis, and the patient’s constitutional symptoms resolved completely on discontinuation of the drug precluding the need for immunosuppressive therapy. Learning points: Continued vigilance and patient education regarding the risk of antithyroid drug-induced agranulocytosis is vital throughout the course of treatment. ANCA-associated vasculitis is a rare adverse effect of antithyroid drug use. Timely discontinuation of the offending drug is vital in reducing end-organ damage and the need for immunosuppressive therapy in drug-induced ANCA-associated vasculitis. Similarities in the pathogenesis of agranulocytosis and drug-induced ANCA-associated vasculitis may offer insight into an improved understanding of vasculitis and agranulocytosis.

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Propylthiouracil-Induced Antineutrophil Cytoplasmic Antibody-Associated Vasculitis after COVID-19 Vaccination

Vaccines ◽

10.3390/vaccines9080842 ◽

2021 ◽

Vol 9 (8) ◽

pp. 842

Author(s):

Saki Okuda ◽

Yasuaki Hirooka ◽

Masafumi Sugiyama

Keyword(s):

Relapsing Polychondritis ◽

Antineutrophil Cytoplasmic Antibody ◽

Japanese Woman ◽

Graves Disease ◽

Proteinase 3 ◽

Disease Treatment ◽

Important Data ◽

Anca Associated Vasculitis ◽

Old Japanese ◽

Oral Glucocorticoids

We report the case of a patient who developed antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) after receiving the coronavirus disease 2019 (COVID-19) vaccine BNT162b (Pfizer–BioNTech). A 37-year-old Japanese woman had been taking propylthiouracil for Graves’ disease. She had erythema on her forearm on the 12th day after receiving the first dose of the vaccine, fever on the 13th day, and redness and swelling of her left auricle on the 25th day. Her serum myeloperoxidase-ANCA and proteinase 3-ANCA levels, which were negative before the Graves’ disease treatment, were elevated. She had unilateral auricular symptoms but no other typical relapsing polychondritis findings. She was diagnosed with propylthiouracil-induced AAV. She was treated with oral glucocorticoids, and her symptoms improved. Propylthiouracil is considered to be the main cause of the onset of AAV in this case, but it cannot be ruled out that BNT162b may have had some effect on the onset of the disease. Although the development of propylthiouracil-induced AAV in this case may have been incidental and unrelated to the vaccination, this report provides important data for evaluating the safety of the vaccine.

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