Concomitant drug- and infection-induced antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis with multispecific ANCA

Med Princ Pract. 2012;21(5):488-91. doi: 10.1159/000337944. Epub 2012 Apr 25.

Abstract

Objective: To report the first case of concomitant drug- and infection-induced antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) in a patient treated with propylthiouracil (PTU) and suffering from tuberculosis.

Presentation and intervention: A 28-year-old woman with PTU-treated hyperthyroidism presented with fever, purpura, pulmonary cavitations and ANCA to myeloperoxidase, bactericidal/permeability-increasing protein (BPI), proteinase-3 and elastase. Skin histopathology confirmed vasculitis. However, sputum examination revealed Mycobacterium tuberculosis. Remission was achieved after PTU withdrawal and treatment with antituberculosis drugs.

Conclusion: Our case confirmed that BPI-ANCA are elevated in active tuberculosis. Multispecific ANCA were helpful for the diagnosis of concomitant PTU- and M. tuberculosis-induced AAV.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antibodies, Antineutrophil Cytoplasmic / adverse effects*
  • Antibodies, Antineutrophil Cytoplasmic / immunology*
  • Antithyroid Agents / adverse effects*
  • Antithyroid Agents / therapeutic use
  • Antitubercular Agents / therapeutic use
  • Female
  • Humans
  • Hyperthyroidism / drug therapy
  • Propylthiouracil / adverse effects*
  • Propylthiouracil / therapeutic use
  • Tuberculosis, Pulmonary / diagnosis
  • Tuberculosis, Pulmonary / drug therapy
  • Vasculitis / chemically induced
  • Vasculitis / diagnosis
  • Vasculitis / etiology*
  • Vasculitis / microbiology

Substances

  • Antibodies, Antineutrophil Cytoplasmic
  • Antithyroid Agents
  • Antitubercular Agents
  • Propylthiouracil