Propylthiouracil-induced anti-neutrophil cytoplasmic antibody-associated vasculitis
Propylthiouracil-induced anti-neutrophil cytoplasmic antibody-associated vasculitis
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DOI：
10.1038/sj.ki.5000387
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发表时间：
2006-04-01
影响因子：
19.6
通讯作者：
Wang, HY
中科院分区：
文献类型：
--
作者：
Zhao, MH;Chen, M;Wang, HY
一名20岁的女性因肺部大出血和肉眼血尿被转诊到北京大学第一医院，北京，中国。入院前2年诊断为Graves病，病情稳定，先用丙基硫氧嘧啶(PTU)300 mg/d治疗，再用PTU 100 mg/d维持治疗。入院前五个月，她主诉心悸，并被发现血清T3和T4升高，甲状腺刺激激素降低。作为回应，当地医生将PTU的剂量改为每天300毫克。此后不久，她开始抱怨关节痛、肌肉痛和皮疹。入院前三个月，她出现咳嗽、咯血和肉眼血尿，随后听力逐渐下降、红眼和体重减轻。入院前一周，她的PTU剂量进一步增加到450 mg/d，随后患者病情加重，出现大量肺出血。入院时体检发现她面色苍白，眼球突出，甲状腺肿。血压120/80毫米汞柱，脉搏96次/分，呼吸频率24次/分，体温37.2℃，体重45公斤。肺部听诊可见零星的呼气喘息和粗大的支气管呼吸音。心脏检查显示心动过速，心音正常，没有杂音、摩擦或跳跃。腹部柔软，不痛。实验数据如表1和表2所示。胸片显示大量肺出血(图1a)。她的血清乙醇固定的中性粒细胞核周胞浆染色阳性，对髓过氧化物酶、乳铁蛋白和天青素具有特异性。抗核抗体和抗肾小球基底膜抗体均为阴性。
A 20-year-old woman was referred to Peking University First Hospital, Beijing, China, owing to massive pulmonary hemorrhage and gross hematuria. She had been well until 2 years before admission when she was diagnosed with Graves' disease and was treated with propylthiouracil (PTU) 300 mg/day first and then maintained with PTU 100 mg/day. Five months before admission, she complained of palpitations and was found to have an elevated serum T3 and T4 and decreased thyroid stimulating hormones. In response, the dose of PTU was changed to 300 mg/day by her local doctors. Shortly thereafter, she started to complain of arthralgia, myalgia, and skin rash. Three months before admission, she developed a cough, hemoptysis, and gross hematuria, and subsequently a gradual decline in her hearing, 'red eye', and weight loss. One week before admission, her PTU dose was further increased to 450 mg/day and then the patient became severely ill with massive pulmonary hemorrhage.At physical examination on admission, her paleness, exophthalmos, and goiter were revealed. The blood pressure was 120/80 mm Hg, the pulse 96 beats/min, the respiratory rate 24 breaths/min, and the temperature 37.2 degrees C. The body weight was 45 kg. Auscultation of the lungs revealed scattered expiratory wheezes and coarse bronchial breath sounds. A cardiac examination revealed tachycardia with normal heart sounds and no murmurs, rubs, or gallops. The abdomen was soft, nontender. There was no edema on lower extremities.Laboratory data are shown in Tables 1 and 2. Chest radiography indicated massive pulmonary hemorrhage ( Figure 1a). Her serum perinuclear cytoplasmic stained pattern on ethanol-fixed neutrophil was positive with specificity to myeloperoxidase, lactoferrin, and azurocidin. Anti-nuclear antibody and anti-glomerular basement membrane antibody were negative.