propylthiouracil and Lung-Diseases

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

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

Topics: Antithyroid Agents; Child, Preschool; Female; Humans; Lung Diseases; Propylthiouracil; Pulmonary Alveoli; Purpura; Vasculitis

Topics: Acute Disease; Adult; Antithyroid Agents; Hemoptysis; Humans; Lung Diseases; Male; 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

Topics: Adult; Female; Fever; Humans; Immune Complex Diseases; Leg Ulcer; Lung Diseases; Propylthiouracil; Purpura; Skin Transplantation; Transplantation, Autologous; Vasculitis

Topics: Aminophylline; Animals; Dexamethasone; Indomethacin; Lung Diseases; Male; Meclofenamic Acid; Oxygen; Propylthiouracil; Rats; Thyroxine; Time Factors; Vitamin E

Topics: Animals; Body Temperature; Dogs; Geriatrics; Hypothermia; Hypothermia, Induced; Injections; Injections, Intravenous; Lung Diseases; Metabolism; Oxygen; Propylthiouracil; Research; Respiratory Function Tests