CASE OF PROPYLTHIOURACIL-INDUCED VASCULITIS ASSOCIATED WITH ANTINEUTROPHIL CYTOPLASMIC ANTIBODY (ANCA) - REVIEW OF LITERATURE

A 39-year-old Japanese woman had been receiving propylthiouracil for 5 years for hyperthyroidism when she developed myalgia, scleritis, prot einuria, fever, and inflammation of the nose. Examination of a renal b iopsy specimen showed focal segmental necrotizing glomerulonephritis. Indirect immunofluorescent staining showed a highly positive perinucle ar pattern of anti-neutrophil cytoplasmic antibody (ANCA) in her serum . Enzyme-linked immunosorbent assay (ELISA) of the ANCA showed positiv ity for anti-proteinase 3, anti-myeloperoxidase, anti-leukocyte elasta se, and anti-lactoferrin, but anti-cathepsin G and anti-lysozyme were negative. Because ELISA showed the titer of anti-leukocyte elastase an tibody to be markedly elevated, we challenged this data by performing dot blot analysis. The patient's serum reacted with the native form, b ut not with denatured leukocyte elastase. Propylthiouracil-induced vas culitis was suspected. Symptoms abated within 2 weeks and all values o f ANCA were reduced after the drug was withdrawn. Vasculitis is a rare side-effect of propylthiouracil therapy. Recently it was reported in association with ANCA. We present the findings of this patient and com pare them with those described in 19 published cases of propylthiourac il-induced vasculitis associated with ANCA.