Premium
Antineutrophil cytoplasmic antibody (ANCA)‐positive cutaneous leucocytoclastic vasculitis associated with antithyroid therapy in Graves' disease
Author(s) -
Miller Robert M,
Savige Judy,
Nassis Labrini,
Cominos Belle I
Publication year - 1998
Publication title -
australasian journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.67
H-Index - 53
eISSN - 1440-0960
pISSN - 0004-8380
DOI - 10.1111/j.1440-0960.1998.tb01257.x
Subject(s) - carbimazole , medicine , anti neutrophil cytoplasmic antibody , propylthiouracil , vasculitis , antithyroid agent , graves' disease , lactoferrin , gastroenterology , pathology , immunology , dermatology , disease , thyroid , biology , genetics
SUMMARY Presented is a case of a 27‐year‐old male with Graves' disease on long‐term proepylthiouracil treatment who, when changed to carbimazole, rapidly developed a petechial and purpuric eruption on the legs, which subsequently flared on treatment with radioiodine. The clinical diagnosis of leucocytoclastic vasculitis was confirmed on skin biopsy. High‐titre antineutrophil cytoplasmic antibodies in a perinuclear pattern (P‐ANCA) were identified. No anti‐myeloperoxidase activity was noted; therefore, the P‐ANGA were classified in the atypical group. The target antigens, as determined by enzyme‐linked immunosorbent assay, were lysozyme, lactoferrin and bactericidal/permeability increasing protein. Propylthiouracil and carbimazole are chemically related antithyroid drugs. There are reports of typical and atypical P‐ANCA ‐positive cutaneous vasculitis due to propylthiouracil. Cutaneous vasculitis associated with atypical P‐ANCA has not been noted previously to be temporally related to carbimazole use. The consideration of thionamides as possible aetiological agents in cases of P‐ANCA‐positive druginduced vasuculitis is suggested.