Can propylthiouracil induce autoimmune-related immunotoxicity?
Introduction. The use of propylthiouracil can be associated with mild adverse reactions, but severe complications such as agranulocytosis and vasculitis can also be seen. Direct toxicity and immune-mediated induction of anti-neutrophile cytoplasmic antibodies have been described as possible mechanis...
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Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade
2022-01-01
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| Series: | Vojnosanitetski Pregled |
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| Online Access: | http://www.doiserbia.nb.rs/img/doi/0042-8450/2022/0042-84502100067B.pdf |
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| author | Bajkin Ivana Golubović Sonja Ičin Tijana Stepanović Kristina Ilić Tatjana |
| author_facet | Bajkin Ivana Golubović Sonja Ičin Tijana Stepanović Kristina Ilić Tatjana |
| author_sort | Bajkin Ivana |
| collection | DOAJ |
| description | Introduction. The use of propylthiouracil can be associated with mild adverse reactions, but severe complications such as 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 is 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. We presented a 61-year-old female patient with Graves’ disease who experienced a fever and throat pain two weeks after propylthiouracil therapy was initiated. Agranulocytosis alongside 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. Further course of treatment was complicated by the occurrence of a generalized erythematous-papillomatous 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’ disease are rare in clinical practice. Prompt discontinuation of the antithyroid drug is of great importance to reduce damage to target organs. 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 the need for a deeper understanding of this topic. |
| format | Article |
| id | doaj-art-0c01dcf362dc4e6e94977dc4cfda5887 |
| institution | DOAJ |
| issn | 0042-8450 2406-0720 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade |
| record_format | Article |
| series | Vojnosanitetski Pregled |
| spelling | doaj-art-0c01dcf362dc4e6e94977dc4cfda58872025-08-20T03:17:14ZengMinistry of Defence of the Republic of Serbia, University of Defence, BelgradeVojnosanitetski Pregled0042-84502406-07202022-01-0179111162116710.2298/VSP210429067B0042-84502100067BCan propylthiouracil induce autoimmune-related immunotoxicity?Bajkin Ivana0Golubović Sonja1https://orcid.org/0000-0003-3716-698XIčin Tijana2https://orcid.org/0000-0002-3886-6518Stepanović Kristina3Ilić Tatjana4University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia + University Clinical Center of Vojvodina, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Novi Sad, SerbiaUniversity of Novi Sad, Faculty of Medicine, Novi Sad, Serbia + University Clinical Center of Vojvodina, Clinic for Nephrology and Clinical Immunology, Novi Sad, SerbiaUniversity of Novi Sad, Faculty of Medicine, Novi Sad, Serbia + University Clinical Center of Vojvodina, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Novi Sad, SerbiaUniversity of Novi Sad, Faculty of Medicine, Novi Sad, Serbia + University Clinical Center of Vojvodina, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Novi Sad, SerbiaUniversity of Novi Sad, Faculty of Medicine, Novi Sad, Serbia + University Clinical Center of Vojvodina, Clinic for Nephrology and Clinical Immunology, Novi Sad, SerbiaIntroduction. The use of propylthiouracil can be associated with mild adverse reactions, but severe complications such as 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 is 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. We presented a 61-year-old female patient with Graves’ disease who experienced a fever and throat pain two weeks after propylthiouracil therapy was initiated. Agranulocytosis alongside 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. Further course of treatment was complicated by the occurrence of a generalized erythematous-papillomatous 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’ disease are rare in clinical practice. Prompt discontinuation of the antithyroid drug is of great importance to reduce damage to target organs. 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 the need for a deeper understanding of this topic.http://www.doiserbia.nb.rs/img/doi/0042-8450/2022/0042-84502100067B.pdfagranulocytosisanti-neutrophil cytoplasmic antibody-associated vasculitisdrug-related side effects and adverse reactionsgraves diseasepropylthiouracil |
| spellingShingle | Bajkin Ivana Golubović Sonja Ičin Tijana Stepanović Kristina Ilić Tatjana Can propylthiouracil induce autoimmune-related immunotoxicity? Vojnosanitetski Pregled agranulocytosis anti-neutrophil cytoplasmic antibody-associated vasculitis drug-related side effects and adverse reactions graves disease propylthiouracil |
| title | Can propylthiouracil induce autoimmune-related immunotoxicity? |
| title_full | Can propylthiouracil induce autoimmune-related immunotoxicity? |
| title_fullStr | Can propylthiouracil induce autoimmune-related immunotoxicity? |
| title_full_unstemmed | Can propylthiouracil induce autoimmune-related immunotoxicity? |
| title_short | Can propylthiouracil induce autoimmune-related immunotoxicity? |
| title_sort | can propylthiouracil induce autoimmune related immunotoxicity |
| topic | agranulocytosis anti-neutrophil cytoplasmic antibody-associated vasculitis drug-related side effects and adverse reactions graves disease propylthiouracil |
| url | http://www.doiserbia.nb.rs/img/doi/0042-8450/2022/0042-84502100067B.pdf |
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