propylthiouracil and Hemoptysis

Pulmonary manifestations of hyperthyroidism not only include pulmonary hypertension and hydrostatic pulmonary oedema, but also treatment/drug-associated pulmonary diseases have to be considered as an exclusion diagnosis. A 27-year-old woman with hypoxaemic respiratory failure under an arterial-venous extra-corporeal membrane oxygenator (AV-ECMO) was admitted to the intensive care unit (ICU). The patient had progressive dyspnoea with haemoptysis, palpitations and failure to thrive. The patient had Graves' disease treated previously with propylthiouracil (PTU). Diffuse alveolar haemorrhage is a non-specific syndrome characterised by evidence of diffuse alveolar damage, exclusion of infectious aetiology and progressively bloodier bronchoalveolar lavage (and/or 20% hemosiderin laden macrophages on cytological examination). PTU associated perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) vasculitis appears to be more common in younger female patients presenting with leukocytoclastic vasculitis, myalgias and arthralgias. The latter compared to non-drug associated ANCA vasculitis which are more common in older males with visceral involvement. PTU-induced ANCA vasculitis prognosis appears to be better compared to primary ANCA syndromes.

Topics: Antibodies, Antineutrophil Cytoplasmic; Antithyroid Agents; Diagnosis, Differential; Enzyme-Linked Immunosorbent Assay; Female; Follow-Up Studies; Graves Disease; Hemoptysis; Humans; Hypoxia; Peroxidase; Propylthiouracil; Respiratory Insufficiency; Thyrotoxicosis

Topics: Acute Disease; Adult; Antithyroid Agents; Hemoptysis; Humans; Lung Diseases; Male; Propylthiouracil; Pulmonary Alveoli; Vasculitis

Propylthiouracil (PTU) is known to be a potential cause of antineutrophil cytoplasmic antibody (ANCA) positive small vessel vasculitis, resulting in glomerulonephritis and diffuse alveolar hemorrhage (DAH). Herein, we describe a 25-year-old pregnant woman who developed a perinulcear ANCA (p-ANCA) and myeloperoxidase ANCA (MPO-ANCA) positive DAH during PTU therapy. The patient improved after corticosteroid therapy and discontinuation of the PTU. Methimazole was prescribed in spite of the risk of recurrence of DAH because of the pregnancy. The patient is currently free from pulmonary problems. Our case shows that the alternative agent, methimazole, can be used to treat hyperthyroidism in a pregnant patient with PTU associated DAH.

Topics: Adult; Antibodies, Antineutrophil Cytoplasmic; Antithyroid Agents; Bronchoscopy; Diagnosis, Differential; Female; Hemoptysis; Humans; Hyperthyroidism; Pregnancy; Pregnancy Complications, Hematologic; Propylthiouracil; Pulmonary Alveoli; Tomography, X-Ray Computed