Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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A Case of Diffuse Alveolar Hemorrhage with Glomerulonephritis after Propylthiouracil Treatment

Propylthiouracil 복용 후 발생한 사구체신염이 동반된 미만성 폐출혈 1예

  • Lee, Ji-Hyun (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine) ;
  • Kim, Min-Su (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine) ;
  • Lee, Jae-Gon (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine) ;
  • Kim, Dae-Sik (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine) ;
  • Yang, Hae-Jin (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine) ;
  • Kang, Kyung-Woo (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine)
  • 이지현 (성균관대학교 의과대학 내과학교실 삼성창원병원 호흡기내과) ;
  • 김민수 (성균관대학교 의과대학 내과학교실 삼성창원병원 호흡기내과) ;
  • 이재곤 (성균관대학교 의과대학 내과학교실 삼성창원병원 호흡기내과) ;
  • 김대식 (성균관대학교 의과대학 내과학교실 삼성창원병원 호흡기내과) ;
  • 양혜진 (성균관대학교 의과대학 내과학교실 삼성창원병원 호흡기내과) ;
  • 강경우 (성균관대학교 의과대학 내과학교실 삼성창원병원 호흡기내과)
  • Received : 2011.09.17
  • Accepted : 2011.10.07
  • Published : 2012.01.30
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Abstract

Propylthiouracil (PTU) is one of the most common drugs used in the treatment of Graves' disease. There are a number of side effects found with PTU use including fever, rash, arthralgia, and flu-like symptoms. Recently antineutrophil cytoplasmic antibodies (ANCA) positive vasculitis after PTU treatment was reported as a rare side effect, which can cause diffuse alveolar hemorrhage and glomerulonephritis. A 45-year-old woman with Graves' disease had been treated with PTU for five months, complained of hemoptysis due to pulmonary alveolar hemorrhage causing anemia, and also had hematuria. Simple chest X-ray and HRCT showed bilateral consolidation and bronchoalveolar lavage fluid revealed alveolar hemorrhage. A serologic test was positive for ANCA against myeloperoxidase and proteinase-3. Such findings suggested that the presence of PTU induced ANCA positive vasculitis. Cessation of PTU and the administration of high dose steroids improved the clinical manifestation, radiologic and serologic findings. We observed ANCA titer serially for 6 years. During the follow up period, ANCA titer decreased slowly and stayed within the acceptable upper normal limit.

Keywords

References

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