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KMID : 1202020100030010050
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Journal of Korean Thyroid Association
2010 Volume.3 No. 1 p.50 ~ p.53
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Propylthiouracil-induced p-ANCA Positive Vasculitis with Neutropenia
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Lee Ju-Hee
Kim Min-Kyung
Jang Hye-Won
Jo Young-Suk
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Abstract
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Propylthiouracil (PTU) is a thiourea antithyroid agent commonly used in the treatment of Graves’ disease. Although PTU is a well tolerable drug, serious adverse events such as antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis have been reported. However, PTU-induced ANCA-positive vasculitis with neutropenia is relatively uncommon manifestation. Here, we describe a 14-year old woman who had taken high dose of PTU for Graves’ disease during 4 years. She presented with 1 week history of fever, arthralgia and erythematous patches on her hands, foots and buttocks. Laboratory examination exhibited marked neutropenia (ANC: 460/mm3) and p-ANCA positivity (anti-myeloperoxidase antibody, 282 AAU (0∼150)). The histology of skin biopsy samples revealed perivascular lymphocytic and eosinophilic infiltration. Furthermore, we could also find fibrinoid necrosis of vessel wall, suggesting vasculitis which was believed to be adverse effect of PTU. Taken together, we diagnosed her as PTU-induced ANCA-positive vasculitis. After discontinuation of the drug, her symptoms were resolved and absolute neutrophil count has been recovered (ANC: 930/mm3).
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KEYWORD
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Propylthiouracil, Vasculitis, Antineutrophil cytoplasmic antibodies
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