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Arai M, Tsuno T, Konishi H, Nishiyama K, Terauchi Y, Inoue R, Shirakawa J. A disproportionality analysis of the adverse effect profiles of methimazole and propylthiouracil in patients with hyperthyroidism using the Japanese Adverse Drug Event Report Database. Thyroid 2023. [PMID: 37130038 DOI: 10.1089/thy.2023.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Antithyroid drugs (ATDs) are frequently used to achieve euthyroidism in patients with hyperthyroidism. ATDs cause characteristic common and rare adverse events; however, comprehensive comparisons between methimazole (MMI) and propylthiouracil (PTU) in terms of adverse events are limited. METHODS In this study, we thoroughly explored adverse events in association with MMI and PTU use with a disproportionality analysis using the Japanese Adverse Drug Event Report (JADER) database and evaluated the prevalence of MMI and PTU prescriptions using the National Database of Health Insurance Claims and Specific Health Checkups (NDB) Open Data Japan. We analyzed 3271 cases of MMI use and 1029 cases of PTU use with respect to 9789 preferred terms (PTs) for adverse events registered in the JADER database by calculating and comparing reporting odds ratios (RORs). RESULTS We found that 8 PTs, including agranulocytosis (p < 0.0001, 4.01-fold), aplasia cutis congenita (p < 0.0001, 123.22-fold), and exomphalos (p = 0.0002, 22.17-fold), demonstrated significantly higher RORs (more than 4-fold) for MMI use than for PTU use. Nineteen PTs, including anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (p < 0.0001, 29.84), rapidly progressive glomerulonephritis (p < 0.0001, 6.44), and pulmonary alveolar hemorrhage (p < 0.0001, 7.77), had RORs for PTU use more than four times those for MMI use. NDB Open Data Japan showed more frequent PTU prescriptions than MMI prescriptions for women of reproductive age. CONCLUSIONS This large-scale study confirmed that a variety of congenital malformations were identified as having significantly high RORs for MMI use, while diseases related to ANCA-associated vasculitis were specific to PTU.
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Affiliation(s)
- Masanori Arai
- Yokohama City University School of Medicine Graduate School of Medicine, 26438, Department of Endocrinology and Metabolism, Yokohama, Kanagawa, Japan;
| | - Takahiro Tsuno
- Gunma University, 12925, Institute for Molecular and Cellular Regulation, Maebashi, Gunma, Japan
- Yokohama City University School of Medicine Graduate School of Medicine, 26438, Department of Endocrinology and Metabolism, Yokohama, Kanagawa, Japan;
| | - Hiromi Konishi
- Yokohama City University School of Medicine Graduate School of Medicine, 26438, Department of Endocrinology and Metabolism, Yokohama, Kanagawa, Japan;
| | - Kuniyuki Nishiyama
- Gunma University, 12925, Institute for Molecular and Cellular Regulation, Maebashi, Gunma, Japan
- Yokohama City University School of Medicine Graduate School of Medicine, 26438, Department of Endocrinology and Metabolism, Yokohama, Kanagawa, Japan;
| | - Yasuo Terauchi
- Yokohama City University School of Medicine Graduate School of Medicine, 26438, Department of Endocrinology and Metabolism, Yokohama, Kanagawa, Japan;
| | - Ryota Inoue
- Gunma University, 12925, Institute for Molecular and Cellular Regulation, Maebashi, Gunma, Japan
- Yokohama City University School of Medicine Graduate School of Medicine, 26438, Department of Endocrinology and Metabolism, Yokohama, Kanagawa, Japan;
| | - Jun Shirakawa
- Gunma University, 12925, Institute for Molecular and Cellular Regulation, Maebashi, Gunma, Japan
- Yokohama City University School of Medicine Graduate School of Medicine, 26438, Department of Endocrinology and Metabolism, Yokohama, Kanagawa, Japan;
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Abstract
Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis that may be caused by an adverse drug reaction. We discuss the clinical presentation and outcomes of 52 cases of drug-induced PG reported to date in the literature. We conducted our literature search for case reports of drug-induced PG using keywords on PubMed and Medical Subject Heading (MeSH) terms on MEDLINE and EMBASE. To assess the probability that each case of PG was related to drug therapy, we used the Naranjo criteria. We identified 44 studies in the literature, with a total of 52 cases of drug-induced PG. The mean Naranjo score for cocaine-induced PG (n = 13) was 9.4, indicating a definite adverse drug reaction, while the mean Naranjo scores for isotretinoin (n = 5), propylthiouracil (n = 5), and sunitinib (n = 5) were 6.2, 6.8, and 7.4, respectively, indicating probable adverse drug reactions. Drugs should be considered as a possible triggering event whenever PG is diagnosed, and clinicians should particularly consider this in patients taking isotretinoin, propylthiouracil, or sunitinib, as well as in patients with a history of cocaine use.
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Affiliation(s)
- Jane Y Wang
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lars E French
- Department of Dermatology, Zürich University Hospital, Zurich, Switzerland
| | - Neil H Shear
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Dermatology, Women's College Hospital, University of Toronto, 76 Grenville St, 5th Floor, Toronto, ON, M5S 1B2, Canada
| | | | - Afsaneh Alavi
- York Dermatology Centre, Toronto, ON, Canada.
- Division of Dermatology, Women's College Hospital, University of Toronto, 76 Grenville St, 5th Floor, Toronto, ON, M5S 1B2, Canada.
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3
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Wu BC, Patel ED, Ortega-Loayza AG. Drug-induced pyoderma gangrenosum: a model to understand the pathogenesis of pyoderma gangrenosum. Br J Dermatol 2017; 177:72-83. [PMID: 27864925 DOI: 10.1111/bjd.15193] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2016] [Indexed: 12/14/2022]
Abstract
Pyoderma gangrenosum (PG) is a rare autoinflammatory condition in which the alteration of neutrophil function and the innate immune response play key roles in its pathogenesis. Cases of PG have been reported in patients being treated with certain medications, which may help us to understand some of the possible pathways involved in the aetiology of PG. The aim of this review is to review the cases of PG triggered by certain drugs and try to thoroughly understand the pathogenesis of the disease. To accomplish this, a PubMed search was completed using the following words: pyoderma gangrenosum, neutrophilic dermatosis, pathophysiology, drug-induced pyoderma gangrenosum. In total, we found 43 cases of drug-induced PG. Most of them were caused by colony-stimulating factors and small-molecule tyrosine kinase inhibitors. We propose that drugs induce PG through various mechanisms such as dysfunctional neutrophil migration and function, dysregulated inflammatory response, promotion of keratinocyte apoptosis and alteration of epigenetic mechanisms. PG is a rare condition with complex pathophysiology and drug-induced cases are even more scarce; this is the main limitation of this review. Understanding the possible mechanisms of drug-induced PG, via abnormal neutrophil migration and function, abnormal inflammation, keratinocyte apoptosis and alteration of epigenetic mechanisms would help to better understand the pathogenesis of PG and ultimately to optimize targeted therapy.
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Affiliation(s)
- B C Wu
- Department of Medicine, Drexel University College of Medicine/Hahnemann University Hospital, Philadelphia, PA, U.S.A
| | - E D Patel
- Virginia Commonwealth University School of Medicine, Richmond, VA, U.S.A
| | - A G Ortega-Loayza
- Center for Wound and Healing, Department of Dermatology, Oregon Health & Science University, 3303 SW Bond Avenue, CHD 16D, Portland, OR, 97034, U.S.A
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4
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Alavi A, French LE, Davis MD, Brassard A, Kirsner RS. Pyoderma Gangrenosum: An Update on Pathophysiology, Diagnosis and Treatment. Am J Clin Dermatol 2017; 18:355-372. [PMID: 28224502 DOI: 10.1007/s40257-017-0251-7] [Citation(s) in RCA: 169] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pyoderma gangrenosum (PG) is a rare inflammatory neutrophilic disorder with prototypical clinical presentations. Its pathophysiology is complex and not fully explained. Recent information regarding the genetic basis of PG and the role of auto-inflammation provides a better understanding of the disease and new therapeutic targets. PG equally affects patients of both sexes and of any age. Uncontrolled cutaneous neutrophilic inflammation is the cornerstone in a genetically predisposed individual. Multimodality management is often required to reduce inflammation, optimize wound healing, and treat underlying disease. A gold standard for the management of PG does not exist and high-level evidence is limited. Multiple factors must be taken into account when deciding on the optimum treatment for individual patients: location, number and size of lesion/ulceration(s), extracutaneous involvement, presence of associated disease, cost, and side effects of treatment, as well as patient comorbidities and preferences. Refractory and rapidly progressive cases require early initiation of systemic therapy. Newer targeted therapies represent a promising pathway for the management of PG, and the main focus of this review is the management and evidence supporting the role of new targeted therapies in PG.
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5
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Pyoderma gangrenosum avec anticorps anti-cytoplasme des neutrophiles de type anti-protéinase 3 (PR3-ANCA) induits par le propylthiouracile. Ann Dermatol Venereol 2017; 144:368-373. [DOI: 10.1016/j.annder.2017.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 07/12/2016] [Accepted: 01/13/2017] [Indexed: 12/16/2022]
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6
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Yamamoto T. Pyoderma gangrenosum: An important dermatologic condition occasionally associated with rheumatic diseases. World J Rheumatol 2015; 5:101-107. [DOI: 10.5499/wjr.v5.i2.101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 04/29/2015] [Indexed: 02/06/2023] Open
Abstract
Pyoderma gangrenosum (PG) presents with refractory, sterile, deep ulcers most often on the lower legs. Clinically, PG exhibits four types, i.e., ulcerative, bullous, pustular, and vegetative types. PG may be triggered by surgical operation or even by minor iatrogenic procedures such as needle prick or catheter insertion, which is well-known as pathergy. PG is sometimes seen in association with several systemic diseases including rheumatoid arthritis (RA), inflammatory bowel disease, hematologic malignancy, and Takayasu’s arteritis. In particular, various cutaneous manifestations are induced in association with RA by virtue of the activation of inflammatory cells (neutrophils, lymphocytes, macrophages), vasculopathy, vasculitis, drugs, and so on. Clinical appearances of ulcerative PG mimic rheumatoid vasculitis or leg ulcers due to impaired circulation in patients with RA. In addition, patients with PG sometimes develop joint manifestations as well. Therefore, it is necessary for not only dermatologists but also rheumatologists to understand PG.
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Lee JY, Lee JM, Lee TH, Jeong HJ, Choi G, Chae JN, Kim JM, Kim SH. A Case of Propylthiouracil induced Antineutrophil Cytoplasmic Antibody Positive Pyoderma Gangrenosum. JOURNAL OF RHEUMATIC DISEASES 2014. [DOI: 10.4078/jrd.2014.21.3.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Ji Yeon Lee
- Division of Rheumatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Ji Min Lee
- Division of Rheumatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Tae Han Lee
- Division of Rheumatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Hye Jin Jeong
- Division of Rheumatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Go Choi
- Division of Rheumatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Jin Nyeong Chae
- Division of Rheumatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Ji-Min Kim
- Division of Rheumatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Sang-Hyon Kim
- Division of Rheumatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
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8
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Chen M, Gao Y, Guo XH, Zhao MH. Propylthiouracil-induced antineutrophil cytoplasmic antibody-associated vasculitis. Nat Rev Nephrol 2012; 8:476-83. [PMID: 22664738 DOI: 10.1038/nrneph.2012.108] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) refers to a group of potentially life-threatening autoimmune diseases. A recent development in this field is the recognition that certain drugs can induce AAV. Among these agents, the drug most often implicated in causing disease is the commonly used antithyroid agent propylthiouracil (PTU). This Review provides an update on PTU-induced AAV. Clinical characteristics of PTU-induced AAV are similar to that of primary AAV, but usually have a milder course and better prognosis, provided early cessation of the disease-causing drug. PTU-induced ANCAs usually react to several components of myeloid granules, which is helpful in differentiating PTU-induced AAV from primary AAV. Early cessation of PTU is crucial in the treatment of PTU-induced AAV. The duration of immunosuppressive therapy might be shorter than in primary AAV, depending on the severity of organ damage, and maintenance therapy is not always necessary.
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Affiliation(s)
- Min Chen
- Renal Division, Department of Medicine, Peking University First Hospital, Xicheng District, Beijing 100034, China
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9
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Wan P, Zhao X, Hunasehally RYP, Shi R, Zheng J. Propylthiouracil-induced ANCA-positive erythema nodosum treated with thalidomide. Int J Dermatol 2012; 51:345-8. [DOI: 10.1111/j.1365-4632.2011.05135.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Wakamatsu K, Mitsuhashi Y, Yamamoto T, Tsuboi R. Propylthiouracil-induced antineutrophil cytoplasmic antibody positive vasculitis clinically mimicking pyoderma gangrenosum. J Dermatol 2011; 39:736-8. [PMID: 22132781 DOI: 10.1111/j.1346-8138.2011.01399.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Yip G, Ekinci E, Lee ST, Jerums G, Grossmann M. Carbimazole-induced agranulocytosis: does antineutrophil cytoplasmic antibody have a role? Intern Med J 2011; 40:300-3. [PMID: 20529040 DOI: 10.1111/j.1445-5994.2009.02143.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Carbimazole is a drug that is widely used for hyperthyroid disorders, such as Graves' disease. Agranulocytosis is a rare idiosyncratic adverse reaction to the drug which is potentially fatal. This report describes a patient with a history of successfully treated pyoderma gangrenosum, who developed agranulocytosis 3 weeks after commencement of carbimazole for Graves' disease. It may give credence to the theory that implicates antineutrophil cytoplasmic antibodies in the pathogenesis of agranulocytosis induced by antithyroid drugs.
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Affiliation(s)
- G Yip
- Department of Medicine, Austin Health, Melbourne, Victoria, Australia.
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12
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Seo JW, Son HH, Choi JH, Lee SK. A Case of p-ANCA-Positive Propylthiouracil-Induced Pyoderma Gangrenosum. Ann Dermatol 2010; 22:48-50. [PMID: 20548880 DOI: 10.5021/ad.2010.22.1.48] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2009] [Revised: 06/22/2009] [Accepted: 06/22/2009] [Indexed: 12/19/2022] Open
Abstract
Propylthiouracil is a common medication used in patients with hyperthyroidism; it can cause perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) in some patients with Graves' disease. This antibody has been associated with various forms of vasculitis and neutrophilic dermatosis. Herein, we report a patient who presented with cutaneous manifestations of pyoderma gangrenosum with simultaneous development of p-ANCAs during PTU therapy for Graves' disease.
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Affiliation(s)
- Jong Won Seo
- Department of Dermatology, Maryknoll Medical Center, Busan, Korea
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13
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Frigui M, Masmoudi A, Kaddour N, Jlidi R, Turki H, Bahloul Z. Dermatose neutrophilique associée à des anticorps anticytoplasme des polynucléaires neutrophiles (ANCA) après prise de benzylthiouracile. Ann Dermatol Venereol 2009; 136:422-6. [DOI: 10.1016/j.annder.2008.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 09/25/2008] [Indexed: 12/16/2022]
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Oumakhir S, Frikh R, Ghfir M, Sedrati O. [A case of pyoderma gangrenosum of favourable outcome after treatment of associated hyperthyroidism]. Ann Dermatol Venereol 2009; 136:367-8. [PMID: 19361708 DOI: 10.1016/j.annder.2008.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Accepted: 10/10/2008] [Indexed: 11/29/2022]
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15
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GAO YING, ZHAO MINGHUI. Review article: Drug-induced anti-neutrophil cytoplasmic antibody-associated vasculitis. Nephrology (Carlton) 2009; 14:33-41. [DOI: 10.1111/j.1440-1797.2009.01100.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
Skin ulcerations may develop as a manifestation of a variety of different diseases or may result from some nondisease phenomena. Inflammatory ulcers refer specifically to those ulcerations in which inflammation is the primary pathologic process resulting in lesion formation; that is, inflammation is the cause rather than the consequence of the ulcer. This review will consider several types of inflammatory ulcers that the clinician may encounter in his or her practice.
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Affiliation(s)
- Mark D Hoffman
- Department of Dermatology, Rush Medical College, Chicago, IL 60612, USA.
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Livideanu C, Lipsker D, Paul C, Juillard J, Schubert B. Pyoderma gangrenosum as initial manifestation of Graves' disease. Clin Exp Dermatol 2006; 31:659-61. [PMID: 16780496 DOI: 10.1111/j.1365-2230.2006.02184.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Pyoderma gangrenosum (PG) is an uncommon ulcerative condition. It is most commonly associated with inflammatory bowel disease, haematological malignancies and autoimmune disease. We report on two patients have developed PG during the initial course of Graves' disease (GD), prior to treatment of this condition. The lesions completely cleared with treatment by colchicine in the first case and with oral ciclosporin in the second case. The report emphasizes that a diagnostics of PG should be considered in patients with GD and skin ulcers.
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Affiliation(s)
- C Livideanu
- Department of Dermatology, Mulhouse General Hospital, and Strasbourg University Hospital, France.
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Gungor K, Gonen S, Kisakol G, Dikbas O, Kaya A. ANCA positive propylthiouracil induced pyoderma gangrenosum. J Endocrinol Invest 2006; 29:575-6. [PMID: 16840840 DOI: 10.1007/bf03344152] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Boulenger-Vazel A, Kupfer-Bessaguet I, Gouedard C, Leberre R, Leroy JP, Sonnet E, Desvignes O, Misery L, Sassolas B. Dermatose neutrophilique associée à des anticorps anticytoplasme des polynucléaires neutrophiles (p-ANCA) induits par le propylthiouracil. Ann Dermatol Venereol 2005; 132:27-31. [PMID: 15746603 DOI: 10.1016/s0151-9638(05)79191-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION We report on a patient who progressively developed polymorphic expressions of neutrophilic dermatosis (Sneddon-Wilkinson subcorneal pustulosis and pyoderma gangrenosum) associated with p-antineutrophil cytoplasmic antibodies (p-ANCA), while receiving propylthiouracil for hyperthyroidism. To our knowledge, such associations have never been published so far. CASE-REPORT A 40 year-old woman was treated with propylthiouracil for Graves'disease. After 16 months of therapy, she noted flares of pustular lesions surrounded with erythematous halo mainly localized on the trunk. The lesions became chronic, and were not improved by potent topical corticosteroids. When first seen in our department in February 2003, the eruption was typical of Sneddon-Wilkinson subcorneal pustulosis. This diagnosis was confirmed by the histological examination of a skin biopsy of a pustule. One month later, she developed an inflammatory progressively ulcerative lesion on the right ankle, typical of pyoderma gangrenosum. The diagnosis was confirmed by the histological examination of a skin biopsy taken on the evolving border of the lesion and showed polynuclear neutrophilic infiltration without vasculitis. Direct immunofluorescence was negative. The presence of serum anti-myeloperoxydase p-ANCA was known for this patient since October 2002. No IgA monoclonal gammapathy was revealed on extensive biological check-up. Systemic oral corticosteroid therapy (1 mg/kg/day) dramatically improved skin lesions with complete healing within 8 weeks. DISCUSSION Propylthiouracil is well known to induce the occurrence of ANCA in 20 to 64p. 100 of patients treated for Graves'disease. The mechanisms involved are badly recognized so far. Cutaneous vasculitis, glomerulonephritis and polychondritis may be clinically associated with those antibodies. Rare observations of neutrophilic dermatosis, mostly Sweet's syndrome, have been described in patients with propylthiouracil-induced ANCA. One case-report described a 44 year-old woman who developed pyoderma gangrenosum associated with propylthiouracil-induced p-ANCA. These manifestations usually appear within 2 years, as our patient. The data in the literature, allows us to report the polymorphic expressions of neutrophilic dermatosis in this patient with p-ANCA which could be related to propylthiouracil. Such association of Sneddon-Wilkinson subcorneal pustulosis and pyoderma gangrenosum with p-ANCA has never been described in this endocrinologic context so far. Furthermore we propose that neutrophilic dermatosis should be inscribed in the list of side effects induced by propylthiouracil therapy.
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Hong SB, Lee MH. A case of propylthiouracil-induced pyoderma gangrenosum associated with antineutrophil cytoplasmic antibody. Dermatology 2004; 208:339-41. [PMID: 15178918 DOI: 10.1159/000077844] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2003] [Accepted: 12/22/2003] [Indexed: 01/27/2023] Open
Abstract
A 27-year-old woman who had been receiving propylthiouracil for 2 years for Graves' disease presented with painful ulceration on the lower limbs which had first appeared 2 weeks previously. Well-circumscribed hemorrhagic ulcerations with ragged borders were noted on both legs. Skin biopsy demonstrated a florid neutrophilic infiltrate and evidence of leukocytoclasis around small blood vessels in the papillary dermis compatible with the diagnosis of pyoderma gangrenosum. A highly positive perinuclear pattern of antineutrophil cytoplasmic antibody with specificities for IgM myeloperoxidase was observed. The authors think that propylthiouracil is associated with the occurrence of pyoderma gangrenosum in this patient.
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Affiliation(s)
- Seok-Beom Hong
- Department of Dermatology, College of Medicine, Kyunghee University, Seoul, Korea
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Thamprajamchit S, Jariengprasert C, Rajatanavin R. Propylthiouracil-Induced Sensorineural Hearing Loss Associated with Antineutrophil Cytoplasmic Antibodies. Endocr Pract 2004; 10:432-7. [PMID: 15760792 DOI: 10.4158/ep.10.5.432] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To report the case of a young woman with Graves' disease in whom ototoxicity developed because of propylthiouracil (PTU)-induced antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. METHODS We present the clinical findings, pertinent laboratory data, and follow-up course of a patient with Graves' disease and bilateral sensorineural hearing loss. We also provide a literature review regarding thionamide-induced ANCA-associated vasculitis. RESULTS In a 22-year-old Thai woman with Graves' disease, tinnitus, hearing impairment in the left ear (with progression to the right ear), and vertigo developed after 3 years of therapy with PTU. Audiograms showed bilateral sensorineural hearing loss with cochlear lesions. She also had low-grade fever, intermittent chronic abdominal pain, weight loss, polyarthralgia, and conjunctivitis. An indirect immunofluorescence test for ANCA was positive. The hearing impairment and tinnitus were gradually reduced after PTU withdrawal and corticosteroid and azathioprine treatment. Definitive therapy by subtotal thyroidectomy was subsequently performed and yielded good results. CONCLUSION This rare case of PTU-induced ANCA-associated vasculitis manifested with ototoxicity in combination with systemic involvement.
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Affiliation(s)
- Sriurai Thamprajamchit
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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22
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Wada N, Mukai M, Kohno M, Notoya A, Ito T, Yoshioka N. Prevalence of serum anti-myeloperoxidase antineutrophil cytoplasmic antibodies (MPO-ANCA) in patients with Graves' disease treated with propylthiouracil and thiamazole. Endocr J 2002; 49:329-34. [PMID: 12201217 DOI: 10.1507/endocrj.49.329] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Patients with Graves' disease (n = 61) treated with propylthiouracil (PTU) or thiamazole (MMI) were studied retrospectively to investigate differences in the prevalence of anti-myeloperoxidase anti-neutrophil cytoplasmic antibodies (MPO-ANCA) in relation to treatment with anti-thyroid drugs. The patients were divided into two groups: PTU-treated group (n = 32) and MMI-treated group (n = 29). There were no significant differences between the two groups in terms of age, gender distribution, or duration of treatment. In the PTU group, 8/32 (25%) patients were positive for MPO-ANCA, whereas in the MMI group, 1/29 (3.4%) patients were positive. There were no significant differences in age, duration, or dosage between the MPO-ANCA positive and negative patients. Most of the MPO-ANCA positive patients were asymptomatic, except for two patients in whom rheumatic arthritis or membranous glomerulonephritis developed. None of the MPO-ANCA positive patients were diagnosed as having classical ANCA-associated vasculitis. Thus, there is a high frequency of MPO-ANCA in patients with Graves' disease treated with PTU, compared with patients treated with MMI, although classical ANCA-associated vasculitis develops in only a few MPO-ANCA positive patients.
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Affiliation(s)
- Norio Wada
- Division of Endocrinology and Metabolism, Department of Medicine, Sapporo City General Hospital, Kita-11, Nishi-13, Chuo-Ku, Sapporo 060-8604, Japan
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