A Case of ANCA-positive Crescentic Glomerulonephritis after Propylthiouracil Treatment in Graves' Disease.
- Author:
Jeong Hoon KIM
1
;
Hyung Wook KIM
;
Eun Chul JANG
;
Woong Ryong JUNG
;
Seung Hyun KO
;
Young Shin SHIN
;
Chul Whee PARK
;
Ki Ho SONG
;
Yeong Jin CHOI
;
Yoon Sik CHANG
;
Byung Kee BANG
Author Information
1. Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. khw@catholic.ac.kr
- Publication Type:Case Report
- Keywords:
Propylthiouracil;
Crescentic glomerulonephritis;
Graves' disease;
ANCA
- MeSH:
Adult;
Antibodies, Antineutrophil Cytoplasmic;
Arthralgia;
Biopsy;
Capillaries;
Cardiomegaly;
Dyspnea;
Enzyme-Linked Immunosorbent Assay;
Exanthema;
Female;
Fever;
Fluorescent Antibody Technique;
Glomerulonephritis*;
Goiter;
Graves Disease*;
Hematuria;
Humans;
Immunoglobulin G;
Immunoglobulin M;
Leukopenia;
Liver;
Mesangial Cells;
Methylprednisolone;
Pharyngitis;
Pleural Effusion;
Prednisolone;
Propylthiouracil*;
Pulmonary Edema;
Renal Insufficiency;
Thorax;
Vasculitis
- From:Korean Journal of Nephrology
2005;24(2):305-312
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Propylthiouracil (PTU) therapy is commonly used in the treatment of Graves' disease, but often accompanies several side effects, including a mild increase in liver enzymes, leukopenia, skin rash, and arthralgia. ANCA-positive vasculitis and crescentic glomerulonephritis have been rarely reported in patients suffering from (with) Graves' disease and treated with PTU. We experienced a rare case of ANCA-positive crescentic glomerulonephritis presenting rapid progressive renal failure in a 30-year-old woman, suffering from Graves' disease and treated with PTU for 6 years. She was admitted with dyspnea for 1 day and fever, gross hematuria, arthralgia and sore throat for several days. Her chest X-ray revealed moderate cardiomegaly, bilateral pulmonary edema, and bilateral pleural effusion. She had a palpable, firm, diffuse goiter. Anti-myeloperoxidase (anti-MPO) antibody and anti-protease 3 (anti-PR3) antibody were both positive by ELISA. A percutaneous renal biopsy showed crescentic golmerulonephritis showing active cellular crescent formation with some inflammatory cell infiltration and mesangial cell proliferation. Cellular crescents were present in 2 of 3 glomeruli. Immunofluorescence stain showed weak granular deposits of IgG, IgM and C3 in the mesangium and capillary wall. ANCA-positive crescentic glomerulonephritis associated with PTU was diagnosed. The patient was started on intravenous methylprednisolone 250 mg 2 times daily, and then oral prednisolone 100 mg every other day and PTU was discontinued. Her renal function was recovered gradually and anti-MPO antibody and anti-PR3 antibody subsequently fell. Second biopsy, 7 months after first biopsy, showed focal global glomerulosclerosis. 16 months after first biopsy. she had stable renal function with mild renal insufficiency and euthyroid state.
