Propylthiouracil-associated anti-neutrophil cytoplasmic antibody-positive small vessel vasculitis:a report of 3 cases and review of literature

Objective To study the clinic pathological characteristics of propylthiouracil(PTU)-in-duced antineutrophil cytoplasmic antibody(ANCA)positive small vessel vasculitis.Methods Three patients with PTU-induced ANCA positive small vessel vasculitis in recent two years were studied and the literature were reviewed.Results All3patients with Graves' disease were female with a mean age of28.3(24~32)years,who had been treated with PTU for2～17years.All3patients had skin,joints,muscle involvment,but no sign of kidney,lung,hematological injury.Sera from all3patients were perinuclear-ANCA positive and had significant raise of myeloperoxidase(90~260EU/ml),one of the patients also had cytoplasmic-ANCA and an-other was ANA positive.Two patients were antithyroglobulin antibody positive.None of the sera from the14PTU-treated patients without vasculitis and31patients with methimazole treatment had perinuclear-AN-CA.All3patients ceased taking PTU immediately and treated with glucocortocoid.One continued the Graves' disease treatment with MMI and another one with CBZ.All3patients had achieved clinical remission,the AN-CA of2patients after treatment turned to be negative in3months.Conclusions PTU can induce ANCA positive small vessel vasulitis.Early diagnosis and withdraw of PTU is important in the treatment.Immunosup-pressive agents may improve the prognosis.