1.Medical College of Jianghan University, Wuhan 430056,China 2.Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China 3.People's Hospital,Wuhan University, Wuhan 430060,China
Objective To retrospectively investigate the clinical features of patients with pulmonary involvement in propylthiouracil (PTU)-associated antineutrophil cytoplasmic autoantibody vasculitis (AAV).The aim of our study was to summarize these data of the reasonable medication and the follow-up treatment for clinician physicians. Methods Clinical features and outcomes of 5 patients developed AAV with pulmonary involvement after treatment with PTU were collected and analyzed.ANCA was detected by both immunofluorescence (IFT) and enzyme linked immunosorbent assay (ELISA). Results Five patients, male 2,female 3, average age(52.7±5.4) years, PTU for 3-10 years, received when PTU-AAV was diagnosed.All patients had positive serum p-ANCA, 4 of them were MPO-ANCA, 1 of them was MPO and PR3-ANCA double positive.All patients present with fever and cough.Two patients of them suffered from dyspnea and developed respiratory failure.Initial diagnosis of all patients was misdiagnosed as pulmonary infection.All patients got renal involvement presented with hematuria and/or proteinuria.All patients withdrew PTU and received steroid therapy,2 of them were treated with cyclophosphamidesimultaneously.All patients got clinical remission with no recurrence during the follow-up period. Conclusion It is important to comprehend PTU-induced AAV and distinguish it from primary vasculitis for clinicians.PTU should be discontinued immediately after diagnosis.Corticosteroids and immunosuppressive agents may be promptly used in patients with vital organ involvements.
JENNETTE J C,NACHMAN P H.ANCA Glomerulonep-hritis and Vasculitis[J].Clin J Am Soc Nephrol,2017,12(10):1680-1691.
LI Z Y,MA T T,CHEN M,et al.The prevalence and mana-gement of anti-neutrophil cytoplasmic antibody-associated vasculitis in China[J].Kidney Dis(Basel),2016,1(4):216-223.
LAMPRECHT P,KERSTEIN A,KLAPA S, et al.Patho-genetic and clinical aspects of anti-neutrophil cytoplasmic autoantibody-associated vasculitides[J].Front Immunol,2018,9:680.
GAO Y,ZHAO M H,GUO X H,et al.The prevalence and target antigens of antithyroid drugs induced antineutrophil cytoplasmic antibodies(ANCA) in Chinese patients with hyperthyroidism[J].Endocr Res,2004,30(2):205-213.
DOLMAN K M,GANS R O,VERVAAT T J,et al.Vasculitis and antineutrophil cytoplasmic autoantibodies associated with propylthiouracil therapy[J].Lancet,1993,342(8872):651-652.
ISHII R,IMAIZUMI M,IDE A,et al.A long-term follow-up of serum myeloperoxidase antineutrophil cytoplasmic antibodies(MPO-ANCA) in patients with Graves disease treated with propylthiouracil[J].Endocr J,2010,57(1):73-79.
WANG C,GOU S J,XU P C,et al.Epitope analysis of anti-myeloperoxidase antibodies in propylthiouracil-induced antineutrophil cytoplasmic antibody-associated vasculitis[J].Arthritis Res Ther,2013,15(6):196.
BALAVOINE A S,GLINOER D,DUBUCQUOI S,et al.Antineutrophil cytoplasmic antibody-positive small-vessel vasculitis associated with antithyroid drug therapy:how significant is the clinical problem?[J].Thyroid,2015,25(12):1273-1281.
CHEN M,GAO Y,GUO X H, et al.Propylthiouracil-induced antineutrophil cytoplasmic antibody-associated vasculitis[J].Nat Rev Nephrol,2012,8(8):476-483.
GAO Y,CHEN M,YE H, et al.Long-term outcomes of patients with propylthiouracil-induced anti-neutrophil cytoplasmic auto-antibody-associated vasculitis[J].Rheumatology(Oxford),2008,47(10):1515-1520.
HELFGOTT S M,SMITH R N.Case records of the Massa-chusetts General Hospital.Weekly clinicopathological exercises.Case 21-2002.A 21-year-old man with arthritis during treatment for hyperthyroidism[J].N Engl J Med,2002,347(2):122-130.
CHEN Y,BAO H,LIU Z,et al.Clinico-pathological features and outcomes of patients with propylthiouracil-associated ANCA vasculitis with renal involvement[J].J Nephrol,2014,27(2):159-164.