Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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A Case of Propylthiouracil Induced Diffuse Pulmonary Hemorrhage

Propylthiouracil 약제 복용으로 유발된 미만성 폐출혈 1예

  • Lee, Sung Yong (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Jung, Jin Yong (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Lee, Kyoung Ju (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Lee, Seung Hyeun (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Kim, Se Joong (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Lee, Eun Joo (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Hur, Gyu Young (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Jung, Hae Chul (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Lee, Sang Yeub (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Kim, Je Hyeong (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Shin, Chol (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Shim, Jae Jeong (Department of Internal Medicine, College of Medicine, Korea University) ;
  • In, Kwang Ho (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Kang, Kyung Ho (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Yoo, Se Hwa (Department of Internal Medicine, College of Medicine, Korea University)
  • 이승룡 (고려대학교 의과대학 내과학교실) ;
  • 정진용 (고려대학교 의과대학 내과학교실) ;
  • 이경주 (고려대학교 의과대학 내과학교실) ;
  • 이승현 (고려대학교 의과대학 내과학교실) ;
  • 김세중 (고려대학교 의과대학 내과학교실) ;
  • 이은주 (고려대학교 의과대학 내과학교실) ;
  • 허규영 (고려대학교 의과대학 내과학교실) ;
  • 정혜철 (고려대학교 의과대학 내과학교실) ;
  • 이상엽 (고려대학교 의과대학 내과학교실) ;
  • 김제형 (고려대학교 의과대학 내과학교실) ;
  • 신철 (고려대학교 의과대학 내과학교실) ;
  • 심재정 (고려대학교 의과대학 내과학교실) ;
  • 인광호 (고려대학교 의과대학 내과학교실) ;
  • 강경호 (고려대학교 의과대학 내과학교실) ;
  • 유세화 (고려대학교 의과대학 내과학교실)
  • Received : 2004.08.18
  • Accepted : 2004.10.12
  • Published : 2005.01.30
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Abstract

Propylthiouracil(PUT) is a drug which used at Grave's disease. But PTU has recently been observed to associated with antineutrophil cytoplasmic antibody(ANCA)-positive vasculitis resulting in, infrequently, diffuse alveolar hemorrhage. We report the case of a patient who developed diffuse pulmonary hemorrhage after she had been taking PTU for two years. She had received a diagnosis of Grave's disease at two years ago. The serologic study was positive for ANCA with myeloperoxidase(MPO) specificity. Bronchoalveloar lavage(BAL) fluid analysis revealed hemosiderinladen macrophages. Such findings suggested propylthiouracil-induced dffuse pulmonary hemorrhage associated with antineutrophil cytoplasmic antibody. To our knowledge, this represents the first documentation in a case of PTU-induced diffuse pulmonary hemorrhage in Korea.

그레이브스병으로 진단받고 2년간 PTU 복용 중 폐포 출혈과 ANCA 양성 소견 보여 PTU에 의해 유발 된 ANCA 관련 혈관염으로 진단된 후 PTU 중단과 고용량 스테로이드와 면역 억제제 사용 후 증상 및 방사선학적으로 호전된 증례를 경험하여 문헌고찰과 함께 보고하는 바이다.

Keywords

References

  1. Berkman EM, Orlin JB, Wolfsdorf J. An anti-neutrophil antibody associated with a propylthiouracil-induced lupus-like syndrome. Transfusion 1983;23:135-8 https://doi.org/10.1046/j.1537-2995.1983.23283172851.x
  2. Dhillon SS, Singh D, Doe N, Qadri AM, Ricciardi S, Schwarz MI. Diffuse alveolar hemorrhage and pulmonary capillaritis due to propylthiouracil. Chest 1999;116:1485-8 https://doi.org/10.1378/chest.116.5.1485
  3. Yamauchi K, Sata M, Machiya J, Osaka D, Wada T, Abe S, et al. Antineutrophil cytoplasmic antibody positive alveolar haemorrhage during propylthiouracil therapy for hyperthyroidism. Respirology 2003;8:532-5 https://doi.org/10.1046/j.1440-1843.2003.00499.x
  4. Gunton JE, Stiel J, Clifton-Bligh P, Wilmshurst E, McElduff A. Prevalence of positive anti-neutrophil cytoplasmic antibody (ANCA) in patients receiving anti-thyroid medication. Eur J Endocrinol 2000;142:587
  5. Katayama K, Hata C, Kagawa K, Noda M, Nakamura K, Shimizu H, et al. Diffuse alveolar hemorrhage associated with myeloperoxidase-antineutrophil cytoplasmic antibody induced by propylthiouracil therapy. Respiration 2002;69:473
  6. Rhee Y, Chung SS, Nam SY, Song YD, Lim SK, Kim KR, et al. A case of propylthiouracil induced anti-neutrophil cytoplasmic antibody (ANCA) positive vasculitis. J Korean Soc Endocrinol 1999;14:757-63
  7. Gunton JE, Stiel J, Caterson RJ, McElduff A. Clinical case seminar: anti‐thyroid drugs and antineutrophil cytoplasmic antibody positive vasculitis. J Clin Endocrinol Metab 1999;84:13-6 https://doi.org/10.1210/jc.84.1.13
  8. Merkel PA. Drugs associated with vasculitis. Curr Opin Rheumatol 1998;10:45-50 https://doi.org/10.1097/00002281-199801000-00007
  9. Green RJ, Ruoss SJ, Kraft SA, Duncan SR, Berry GJ, Raffin TA. Pulmonary capillaritis and alveolar hemorrhage: update on diagnosis and management. Chest 1996;110:1305-16 https://doi.org/10.1378/chest.110.5.1305
  10. Kawachi Y, Nukaga H, Hoshino M, Iwata M, Otsuka F. ANCA-associated vasculitis and lupus-like syndrome caused by methimazole. Clin Exp Dermatol 1995;20:345-7 https://doi.org/10.1111/j.1365-2230.1995.tb01340.x
  11. Jiang X, Khursigara G, Rubin RL. Transformation of lupus-inducing drugs to cytotoxic products by activated neutrophils. Science 1994;266:810-3 https://doi.org/10.1126/science.7973636
  12. von Schmiedeberg S, Goebel C, Gleichmann E, Uetrecht J. Neutrophils and drug metabolism. Science 1995;268:585-6
  13. Lee E, Miki Y, Katsura H, Kariya K. Mechanism of inactivation of myeloperoxidase by propylthiouracil. Biochem Pharmacol 1990;39:1467-71 https://doi.org/10.1016/0006-2952(90)90428-N
  14. Ohtsuka M, Yamashita Y, Doi M, Hasegawa S. Propylthiouracil-induced alveolar haemorrhage associated with antineutrophil cytoplasmic antibody. Eur Respir J 1997;10:1405-7
  15. Harper L, Cockwell P, Savage CO. Case of propylthiouracil-induced ANCA associated small vessel vasculitis. Nephrol Dial Transplant 1998;13:455-8 https://doi.org/10.1093/oxfordjournals.ndt.a027846