대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Diffuse Pulmonary Hemorrhage associated with PTU-Induced ANCA-Positive Vasculitis

Radiologic Findings

A 57-year-old woman admitted for evaluation of mild dyspnea and anemia. She had been diagnosed as having hyperthyroidism and treated with propylthiouracil (PTU) for 2 years. Chest radiograph and HRCT of the lung shows diffuse ground glass opacity combined with smoothly thickened interlobular septa in both lungs.

Bronchoscopy and BAL revealed pulmonary hemorrhage. Her hemoglobin level dropped to 4.7 g/dL. The serum was positive for antineutrophil cytoplasmic antibody (ANCA). The other possible causes of DPH were ruled out clinically. She quitted taking PTU and took a steroid pulse therapy. Follow up CBC and chest radiograph show improvement of serum hemoglobin level and radiographic abnormality.

Brief Review

Propylthiouracil (PTU) is known to cause vasculitis as a rare complication. Overall incidence of important side effects of PTU varies from 1~ 5%. Rare but serious complications include agranulocystosis, hepatotoxicity, and drug-induced vasculitis. PTU is also known to cause immunologic reactions such as drug-induced lupus. The mechanism of PTU-induced ANCA-positive vasculitis is not fully understood. Vasculitis associated with PTU may affect any organ. Diffuse pulmonary hemorrhage due to an ANCA-positive vasculitis associated with PTU is an unusual but important syndrome to recognize because the discontinuation of PTU combined with the initiation of immunosuppresive therapy results in recovery.

Elevated ANCA level associated vasculitis have been reported by other drugs such as hydralazine, antithyroid medication (propythiouracil, methimazole, carbimazole), penicillamine, minocycline, and clozapine.

References

1. Dhillon et al. Diffuse Alveolar Hemorrhage and pulmonary Capillaritis Due to Propylthiouracil. Chest. 1999;116:1485-1488.
2. Harper et al. Case of propylthiouracil-induced ANCA associated smll vessel vasculitis. Nephrol Dial Transplant. 1998;13:455-458

Keywords

Lung, Iatrogenic lung disease, Vasculitis, Drug complication,