May propylthiouracil induce autoimmune-related immunotoxicity?
2021
Introduction. The use of propylthiouracil can be associated with mild adverse
reactions, but severe complications like agranulocytosis and vasculitis can
also be seen. Direct toxicity and immune-mediated induction of
anti-neutrophile cytoplasmic antibodies have been described as possible
mechanisms responsible for agranulocytosis. The majority of vasculitis are
antimyeloperoxidase antibodies associated, but the exact mechanism for
anti-neutrophile cytoplasmic antibodies-associated vasculitis as an adverse
effect of propylthiouracil treatment is still unclear. Case report. Here we
present a case of a female patient who presented with fever and throat pain
two weeks after propylthiouracil therapy was initiated. Agranulocytosis
alongside with basal left sided pneumonia was noted. Propylthiouracil was
discontinued, and the treatment with broad spectrum antibiotics was started,
as well as Lugol’s solution, methylprednisolone, and granulocyte-colony
stimulating factor. The following course of treatment was complicated by the
occurrence of a generalized erythematous-papullomatous rash. The patient was
diagnosed with agranulocytosis and antimyeloperoxidase, anti-neutrophile
cytoplasmic antibodies positive vasculitis as an adverse effect of
propylthiouracil. Conclusion. Patients presenting with concomitant
agranulocytosis and anti-neutrophile cytoplasmic antibodies-associated
vasculitis as a complication of propylthiouracil therapy for Graves’s
disease are rare in clinical practice. Prompt discontinuation of antithyroid
drug is of great importance. Similarities in the pathogenesis of both
conditions could be the potential explanation for these two adverse events
occurring at the same time which points out to the need for a deeper
understanding of this topic.
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