propylthiouracil and Hemorrhage

Topics: Adult; Antibodies, Antineutrophil Cytoplasmic; Female; Glomerulonephritis; Hemorrhage; Humans; Propylthiouracil; Pulmonary Circulation; Radiography, Thoracic; Vasculitis

We described a case of pulmonary hemorrhage associated with myeloperoxidase-antineurophil cytoplasmic antibodies (MPO-ANCA) without renal involvement during propylthiouracil (PTU) treatment. A 36-years old female was admitted to our hospital because of progressive dyspnea with hemosputum after flu-like symptom and episcleritis. She had been receiving PTU for three years to Graves' disease. On admission her chest Xp showed bilateral massive infiltrative shadow and bronchofiberscopy demonstrated pulmonary hemorrhage. MPO-ANCA and anti-thyroperoxidase antibodies were positive, but she had normal urinalysis and normal renal function. After withdraw of PTU, pulmonary hemorrhage disappeared. But 15 days later pulmonary hemorrhage recurred associated with high MPO-ANCA titer. Corticosteroid bolus therapy and oral cyclophasphamide administration improved pulmonary hemorrhage, and MPO-ANCA titer also decreased. It is suggested that MPO-ANCA and PTU might be closely related to the pathogenesis of pulmonary hemorrhage in this case.

Topics: Adult; Antibodies, Antineutrophil Cytoplasmic; Antithyroid Agents; Arteritis; Female; Graves Disease; Hemorrhage; Humans; Lung Diseases; Peroxidase; Propylthiouracil

Propylthiouracil is a drug used to treat hyperthyroidism. It can cause several side effects including pulmonary disorders that, although rare, can be severe. The authors describe the case of a woman treated with propylthiouracil who developed diffuse alveolar haemorrhage with severe respiratory failure and anaemia, which improved with discontinuation of the antithyroid drug and on starting systemic corticosteroid therapy.

Topics: Aged; Antithyroid Agents; Diagnosis, Differential; Female; Hemorrhage; Humans; Hyperthyroidism; Lung Diseases; Propylthiouracil; Pulmonary Alveoli; Tomography, X-Ray Computed; Treatment Outcome; Vasculitis

The side effects of propylthiouracil, including cytopenia and vasculitis, are well established.  We present an interesting case in which cytopenia and cutaneous vasculopathy occurred concomitantly in a critically ill patient.  The patient was initially treated for suspected infection until dermatologic and rheumatologic workup revealed ANCA-positivity and vasculopathy on histopathology, most consistent with an atypical presentation of ANCA-positive vasculitis.  Upon initiation of immunosuppressive therapy, the patient's condition rapidly improved emphasizing the importance of early recognition of this condition.

Topics: Adult; Anorexia; Anti-Inflammatory Agents; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; Antithyroid Agents; Blister; Eyelid Diseases; Fatigue; Female; Graves Disease; Hemorrhage; Humans; Immunosuppressive Agents; Methylprednisolone; Pancytopenia; Pharyngitis; Prednisone; Propylthiouracil; Respiratory Insufficiency

A 69-year-old woman had received oral treatment of propylthiouracil (PTU) under a diagnosis of hyperthyroidism for 35 years. In the first 10 days of January 2009, she noticed the development of a cough. In February of the same year, she consulted a clinic with bloody sputum. Chest X-ray films revealed diffuse infiltration in both lungs, and she came to our hospital for further examination. An alveolar hemorrhage was identified by bronchial alveolar lavage testing. Because the cough was relieved by stopping PTU administration and there has been no relapse during 2-year follow-up, this case was diagnosed as PTU-induced diffuse alveolar hemorrhage. Her myeloperoxidase (MPO) -anti-neutrophil cytoplasmic antibody (ANCA) level was 55 EU, suggesting ANCA-associated angitis. However, as a drug lymphocyte stimulation test to PTU was also positive and her MPO-ANCA level was not elevated, the onset mechanism of this case was unclear.

Topics: Aged; Antithyroid Agents; Female; Hemorrhage; Humans; Propylthiouracil; Pulmonary Alveoli; Time Factors

Propylthiouracil, a drug commonly used to treat hyperthyroidism, is known to cause antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis as a rare complication. The wide clinical spectrum of propylthiouracil-induced vasculitis ranges from mild forms with rash and/or arthralgia to severe forms with renal or pulmonary involvement, which can be critical and life-threatening if left unrecognized and untreated. Given its rarity and exceedingly variable clinical presentations, diagnosis may be challenging, and delayed diagnosis is not uncommon without a high index of suspicion, as illustrated by this report of a 17-year-old girl with Graves' disease who developed occult pulmonary hemorrhage as an overlooked rare presentation of ANCA-associated vasculitis after administration of propylthiouracil. Associated clinical features included fever, fatigue, palpable purpura, polyarthritis, and nephritis. Positive findings on chest radiography prompted the bronchoalveolar lavage procedure, which led to the identification of pulmonary hemorrhage. Skin biopsy showed leukocytoclastic vasculitis. Serologic test results were positive for perinuclear ANCA, cytoplasmic ANCA, myeloperoxidase-ANCA, proteinase 3-ANCA, and cryoglobulins but negative for antinuclear antibody, anti-double-stranded DNA, rheumatoid factor, and anti-hepatitis C virus antibody. The symptoms resolved after discontinuation of propylthiouracil and a few months of corticosteroids and azathioprine. This report highlights the necessity for physicians to keep alert for the protean manifestations of propylthiouracil-induced vasculitis.

Topics: Adolescent; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; Antithyroid Agents; Female; Hemorrhage; Humans; Lung Diseases; Propylthiouracil

Propylthiouracil (PTU) can effectuate antineutrophil cytoplasmic antibodies (ANCA)-positive vasculitis. We report a case of severe, PTU-induced leucocytoclastic vasculitis with diffuse pulmonary hemorrhage within a month of initiating PTU. Emergent plasmapheresis was initiated with excellent clinical response. A clinical suspicion for this potential side effect coupled with early cessation of the drug is generally adequate. Clinical manifestations, posited pathogenetic mechanisms, and therapeutic strategies, including the role of plasmapheresis, are discussed.

Topics: Aged; Antithyroid Agents; Bronchoalveolar Lavage Fluid; Female; Hemorrhage; Humans; Lung Diseases; Plasmapheresis; Propylthiouracil; Vasculitis, Leukocytoclastic, Cutaneous

The patient was a 62-year-old female. In June 1999, thiamazole (MMI) was orally administered under a diagnosis of hyperthyroidism. However, drug exanthema developed. In July, oral administration of propylthiouracil (PTU) was started. On October 20, 2005, palpitation and exertional dyspnea occurred. On November 1, bloody sputum was noted, and the patient consulted our hospital on November 8. In addition to severe anemia, chest X-ray and CT revealed diffuse infiltration in the bilateral lungs. The patient was admitted for detailed examination and treatment. After admission, the myeloperoxidase (MPO)-anti-neutrophil cytoplasmic antibody (ANCA) level was 390 EU, suggesting ANCA-associated angitis. PTU was discontinued, and steroid pulse therapy resulted in the disappearance of alveolar hemorrhage and hematuria. Transbronchial lung biopsy suggested alveolar hemorrhage, and kidney biopsy showed glomerular necrosis and interstitial infiltration of inflammatory cells, suggesting PTU-induced ANCA-associated angitis. Posttreatment with prednisolone at 30 mg/day gradually decreased the MPO-ANCA level. There has been no relapse during the 2-years follow-up.

Topics: Antibodies, Antineutrophil Cytoplasmic; Female; Glomerulonephritis; Hemorrhage; Humans; Middle Aged; Peroxidase; Propylthiouracil; Pulmonary Alveoli; Vasculitis

Propylthiouracil (PTU) has been held responsible for diffuse alveolar hemorrhage (DAH) with positive antineutrophil cytoplasmic antibody (ANCA) and capillaritis. We describe a case of a 23-year-old pregnant female with Grave's disease treated with PTU who presented with flu-like symptoms and progressive dyspnea. Open lung biopsy showed DAH without evidence of capillaritis. All serologies were negative. Five days after PTU withdrawal and intravenous steroid therapy, the patient improved dramatically. She remained symptom free without relapse 9 months after the episode. To the best of our knowledge, this is the first reported case of PTU-related alveolar hemorrhage with negative serologic markers and without capillaritis.

Topics: Adult; Antithyroid Agents; Biomarkers; Female; Graves Disease; Hemorrhage; Humans; Lung; Lung Diseases; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Propylthiouracil

We reported the case of pulmonary alveolar hemorrhage caused by propylthiouracil (PTU) with severe respiratory failure and anemia, who improved with PTU discontinuance and steroid therapy. A 35-year-old woman presented with pyrexia, shortness of breath, and arthralgia. Her chest radiograph and CT showed diffuse ground-glass opacities, and her arterial blood gas analysis revealed severe respiratory failure. Laboratory results included a hemoglobin level of 5.2 g/dl, and a myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) level of 203 EU (normal range <9.0 EU). As bronchoalveolar lavage (BAL) fluid showed fresh blood-like fluid containing hemosiderin-laden macrophages, pulmonary alveolar hemorrhage was diagnosed. Since she had been taking PTU for 4 years, PTU was immediately discontinued. Steroid pulse therapy was performed, followed by oral prednisolone 30 mg per day, and her symptoms and chest radiograph findings rapidly improved. Based on the time-course changes, MPO-ANCA may have been involved in the development of pulmonary alveolar hemorrhage.

Topics: Adult; Antibodies, Antineutrophil Cytoplasmic; Antithyroid Agents; Female; Hemorrhage; Humans; Hyperthyroidism; Lung Diseases; Methylprednisolone; Peroxidase; Prednisolone; Propylthiouracil; Pulmonary Alveoli; Pulse Therapy, Drug; Respiratory Insufficiency; Treatment Outcome

We report on a case of pulmonary capillaritis with diffuse alveolar hemorrhage in a child due to propylthiouracil (PTU). PTU treatment is a rare cause of pulmonary capillaritis in adults; we report on the first case in a pediatric patient. The treatment of pulmonary capillaritis often requires corticosteroid therapy, other immunosuppressive medications, or withdrawal of the causative agent. Our patient recovered completely after treatment with a limited course of corticosteroids and removal of PTU.

Topics: Adrenal Cortex Hormones; Antithyroid Agents; Capillaries; Child; Female; Hemorrhage; Humans; Hyperthyroidism; Inflammation; Lung; Lung Diseases; Propylthiouracil

A 50-year-old woman had been treated with propylthiouracil (PTU) for hyperthyroidism. She was admitted to our hospital because of hemosputum, and severe hypoxemia developed. The CT scan showed diffuse infiltration in both lung fields, bronchoalveolar lavage fluid revealed diffuse alveolar hemorrhage, and the level of myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) was high; and therefore diffuse alveolar hemorrhage associated with MPO-ANCA positive vasculitis induced by PTU was diagnosed. Following corticosteroid therapy initiated after the termination of PTU, the pulmonary infiltration rapidly improved and the patient's MPO-ANCA level returned to normal. Recrudescence of diffuse alveolar hemorrhage occurred following a reduction in steroids, but no recurrence was found after cyclophosphamide therapy was combined with steroid therapy. During the course of therapy, various cardiac conducting system abnormalities which correlate with the course of steroid therapy were found, indicating that cardiac conducting system abnormalities may be associated with MPO-ANCA-positive vasculitis.

Topics: Antibodies, Antineutrophil Cytoplasmic; Antithyroid Agents; Bundle-Branch Block; Female; Heart Block; Hemorrhage; Humans; Hyperthyroidism; Lung Diseases; Middle Aged; Peroxidase; Propylthiouracil; Pulmonary Alveoli; Vasculitis

Recently, propylthiouracil (PTU) has been thought to be one of the possible causes of antineutrophil cytoplasmic antibody (ANCA)-associated small vessel vasculitis syndrome, resulting in glomerulonephritis and, infrequently, diffuse alveolar haemorrhage (DAH). The mechanism of ANCA-positive vasculitis during PTU therapy is still unknown. Herein, we describe the case of a 59-year-old woman who developed myeloperoxidase (MPO)- and proteinase 3 (PR3)-ANCA positive DAH, without any other organ system involvement, during PTU therapy. Diminution and discontinuation of PTU resulted in a positive response. To our knowledge, this is the first documentation of both MPO- and PR3-ANCA-positive DAH, without systemic manifestations, developing during PTU therapy.

Topics: Antibodies, Antineutrophil Cytoplasmic; Antithyroid Agents; Female; Hemorrhage; Humans; Hyperthyroidism; Lung Diseases; Methylophilaceae; Middle Aged; Myeloblastin; Propylthiouracil; Pulmonary Alveoli; Serine Endopeptidases

Topics: Aged; Antibodies, Antineutrophil Cytoplasmic; Antithyroid Agents; Female; Hemorrhage; Humans; Hyperthyroidism; Lung Diseases; Propylthiouracil; Pulmonary Alveoli; Vasculitis

A 62-year-old woman had been treated with propylthiouracil(PTU) for hyperthyroidism. Because bloody sputum, dyspnea, and severe hypoxemia developed, the patient was admitted to our hospital. Chest X-ray and chest computed tomographic (CT) films disclosed diffuse infiltrative shadows in both lung fields. Bronchoalveolar lavage revealed abundant hemosiderin-laden macrophages. Alveolar hemorrhage associated with myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) positive vasculitis syndrome was diagnosed because of the high serum level of MPO-ANCA. After the initiation of steroid therapy and termination of PTU, the infiltrative shadows in both lung fields disappeared, PaO2 improved, and MPO-ANCA decreased. There have been some reports of MPO-ANCA positive vasculitis syndrome developing during PTU therapy, but most were concerned with renal disease. We concluded that PTU and similar agents should be given consideration as one of the possible causes of MPO-ANCA-induced alveolar hemorrhage.

Topics: Antibodies, Antineutrophil Cytoplasmic; Antithyroid Agents; Female; Hemorrhage; Humans; Hyperthyroidism; Lung Diseases; Middle Aged; Peroxidase; Propylthiouracil; Pulmonary Alveoli; Syndrome; Vasculitis

Propylthiouracil (PTU) has recently been observed to be associated with antineutrophil cytoplasmic antibody (ANCA)-positive small vessel vasculitis, resulting in crescentic glomerulonephritis and, infrequently, diffuse alveolar hemorrhage (DAH). We describe a case of a 23-year-old pregnant woman who developed a perinuclear ANCA and antimyeloperoxidase-positive small vessel vasculitis manifesting as DAH and crescentic glomerulonephritis after she began taking PTU. An open lung biopsy was consistent with pulmonary capillaritis. She responded to corticosteroid therapy and discontinuation of PTU. DAH can be caused by pulmonary capillaritis, bland hemorrhage, or diffuse alveolar damage. To our knowledge, this represents the first documentation of an underlying pulmonary capillaritis in a case of PTU-induced DAH.

Topics: Adult; Antimetabolites; Biopsy; Capillaries; Female; Glucocorticoids; Hemorrhage; Humans; Hyperthyroidism; Lung; Lung Diseases; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Trimester, First; Propylthiouracil; Pulmonary Alveoli; Radiography, Thoracic; Vasculitis

Propylthiouracil (PTU) is known to cause vasculitis as a rare complication. We report the case of a patient who developed alveolar haemorrhage and haematuria whilst treated with PTU. The serum was positive for antineutrophil cytoplasmic antibody (ANCA) with myeloperoxidase (MPO) specificity (MPO-ANCA). All symptoms resolved completely after discontinuation of PTU. Alveolar haemorrhage or pulmonary-renal syndrome associated with antineutrophil cytoplasmic antibody with myeloperoxidase specificity may be a new complication of propylthiouracil therapy.

Topics: Adult; Antibodies, Antineutrophil Cytoplasmic; Antithyroid Agents; Female; Graves Disease; Hemorrhage; Humans; Lung Diseases; Peroxidase; Propylthiouracil; Radiography

Topics: Adult; Antibodies, Antineutrophil Cytoplasmic; Autoantibodies; Female; Hemorrhage; Humans; Lung Diseases; Propylthiouracil; Pulmonary Alveoli

A case of bleeding during operation due to propylthiouracil-induced thrombocytopenia is reported. A 55 year old male who had been treated with propylthiouracil for two months before operation underwent otherwise uneventful cervical laminectomy. Perioperatively he was transfused seven units of whole blood, two units of packed red cells, six units of platelets and two units of fresh frozen plasma for the estimated blood loss of 5500 ml. The patient underwent thyroidectomy without incident 45 days after withdrawal from propylthiouracil. The value of the preoperative coagulation studies of the patient treated with propylthiouracil is discussed.

Topics: Hemorrhage; Humans; Hyperthyroidism; Intraoperative Complications; Male; Middle Aged; Propylthiouracil; Thrombocytopenia

Topics: Acute Disease; Aminocaproates; Animals; Aprotinin; Azathioprine; Bile; Bile Ducts; Convalescence; Dogs; Hemorrhage; Injections; Pancreatitis; Plasma; Propylthiouracil; Trypsin

Topics: Adolescent; Female; Goiter; Hemorrhage; Humans; Hyperthyroidism; Hypoparathyroidism; Hypothyroidism; Iodine; Methylthiouracil; Postoperative Care; Postoperative Complications; Potassium Iodide; Preoperative Care; Propylthiouracil; Thyroid Diseases; Thyroidectomy; Thyroiditis; Time Factors; Vocal Cord Paralysis

Topics: Female; Hemorrhage; Humans; Hypoprothrombinemias; Middle Aged; Propylthiouracil; Prothrombin Time; Thyroidectomy

Topics: Adrenal Glands; Animals; Edema; Hemorrhage; Hyperemia; Necrosis; Propylthiouracil; Rats; Thyroxine

Topics: Animals; Anti-Bacterial Agents; Dogs; Gastrointestinal Hemorrhage; Hemorrhage; Hypothermia; Hypothermia, Induced; Mortality; Neomycin; Pancreatic Juice; Pancreatitis; Propylthiouracil; Research; Tetracycline

Topics: Gastrointestinal Hemorrhage; Gastrointestinal Tract; Hemorrhage; Hyperthyroidism; Propylthiouracil