propylthiouracil and Antiphospholipid-Syndrome

To describe a case of propylthiouracil-induced lupus, complicated with antiphospholipid syndrome and acute ischemic stroke.. Case report.. Academic medical center.. A 27-year-old man with a diagnosis of Graves disease developed multiple ischemic strokes 2 weeks after starting treatment with propylthiouracil. Thyrotoxicosis and abnormal hypercoagulable and rheumatological profiles were remarkable, with prolonged partial thromboplastin time, elevated anticardiolipin antibody level, and positive antinuclear antibody, lupus anticoagulant, Sjögren antibody, and anti-double-stranded DNA antibody test results, which were more than 8-fold greater than normal values. No clinical manifestations of systemic lupus erythematosus were present.. Discontinuation of propylthiouracil and treatment with radioactive iodine.. Hyperthyroidism resolved and anti-double-stranded DNA antibodies returned to normal levels. Eventually, antiphospholipid syndrome was diagnosed. He was treated with oral anticoagulation and remained asymptomatic for 1 year of follow-up.. In this young man with Graves hyperthyroidism, treatment with propylthiouracil was associated with transient autoimmune reactions suggestive of drug-induced lupus, antiphospholipid syndrome, and acute ischemic stroke.

Topics: Adult; Antiphospholipid Syndrome; Antithyroid Agents; Brain Ischemia; Follow-Up Studies; Graves Disease; Humans; Lupus Erythematosus, Systemic; Male; Propylthiouracil; Stroke

Topics: Antibodies, Antineutrophil Cytoplasmic; Antiphospholipid Syndrome; Biopsy, Needle; Dose-Response Relationship, Drug; Endoscopy, Gastrointestinal; Female; Follow-Up Studies; Gastric Mucosa; Humans; Hyperthyroidism; Immunohistochemistry; Intestinal Diseases; Methylprednisolone; Middle Aged; Propylthiouracil; Severity of Illness Index; Treatment Outcome; Ulcer; Vasculitis, Leukocytoclastic, Cutaneous

A 48 year old white woman was admitted to the hospital because of several bouts of migratory polyarthritis, weight loss, fever, and abdominal pain over a period of 15 months. She had been taking propylthiouracil 100 mg daily for three years for hyperthyroidism treatment. A test for antineutrophil cytoplasmic autoantibodies (ANCA) was positive with a perinuclear pattern of staining. Antiphospholipid antibodies were also detected. Colonoscopy showed several ulcers on intestinal mucosa and the biopsy specimen showed intense microscopic vasculitis. The patient is well after methylprednisolone pulse therapy and eight months of oral azathioprine. A surveillance colonoscopy showed complete healing of intestinal ulcers. No recurrence of symptoms has occurred and autoantibodies are negative, 10 months after treatment finished. The sequence of events suggests a propylthiouracil induced vasculitis p-ANCA positive and an antiphospholipid syndrome. This is the first report of colonic ulcers diagnosed and successfully treated in such circumstances.

Topics: Antiphospholipid Syndrome; Antithyroid Agents; Colonic Diseases; Female; Humans; Hyperthyroidism; Middle Aged; Propylthiouracil; Ulcer; Vasculitis