丙基硫氧嘧啶导致抗中性粒细胞胞浆抗体阳性血管炎一例报告

Antineutrophil cytoplasmic autoantibody positive vasculitis induced by propylthiouracil: a case report

目的 报告 1例由于服用丙基硫氧嘧啶 (PTU)导致的抗中性粒细胞胞浆抗体 (ANCA)阳性的血管炎。方法 根据病史、症状、血清学及肾活组织病理检查结果 ,结合文献进行分析。结果 12岁女性患儿 ,以肉眼血尿、蛋白尿起病 ,伴肾功能轻度受损 ,ANCA检查阳性 ,肾活检符合寡免疫小血管炎。结合发病前有服用PTU 5年史而诊为PTU导致之NACA阳性小血管炎。经停用PTU ,给予泼尼松、环磷酰胺治疗 ,随访 3个月症状明显好转 ,ANCA MPO滴度下降。结论 PTU可导致ANCA阳性的血管炎 ,及时诊治可改善预后。

Objective Propylthiouracil (PTU) as a drug used during the treatment of hyperthyroidism could induce antineutrophil cytoplasmic autoantibody-positive vasculitis. Here the author reported a childhood case of antineutrophil cytoplasmic autoantibody-positive vasculitis induced by PTU, which is rarely described. Methods The diagnosis was made according to the symptoms, signs, serum markers and renal biopsy, and the relevant literature was reviewed. Results The 12-year-old girl presented with gross hematuria, proteinuria, renal function damage [Ccr 52.46 ml/(min. 1.73m 2)], positive antineurophil cytoplasmic autoantibody (ANCA-MPO) (MPO ELISA 140%) and a vasculitis lesion in the renal biopsy sample. She had been treated with PTU for 5 years because of Graves disease. After the diagnosis, the PTU was withdrawn, and prednisone (40 mg/d) and cyclophosphamide (25 mg, Bid) were applied. Three weeks after the therapy with prednisone and cyclophosphamide the gross hematuria disappeared. Three months after the treatment the renal function returned to normal [Ccr 124 mg/(min·1.73 m 2)], and the titer of ANCA-MPO decreased from 140% to 57%. Conclusion PTU may induce antineutrophil cytoplasmic autoantibody positive vasculitis. A right diagnosis and treatment can improve its prognosis of the disease.