丙基硫氧嘧啶致以肺出血为首发症状的抗中性粒细胞胞浆抗体相关小血管炎1例报告并文献复习

目的报告1例由于服用丙基硫氧嘧啶(PTU)导致的以肺出血为首发症状的儿童抗中性粒细胞胞浆抗体(ANCA)阳性血管炎病例并文献复习,以提高儿科医师对此疾病的认识。方法根据患儿的病史、症状、血清学及各项辅助检查结果,结合近期相关文献复习进行回顾性分析。结果患儿因甲状腺功能亢进服用PTU治疗3年,药物加量后出现肺出血,同时伴镜下血尿、蛋白尿、关节症状和皮疹,核周型-ANCA阳性。诊断为PTU导致的ANCA相关小血管炎。经停用PTU、泼尼松治疗,患儿肺部症状、体征得到明显改善。结论 PTU可引起ANCA相关小血管炎,及时停用PTU以及应用糖皮质激素治疗,可改善预后。

Pulmonary hemorrhage as a presentation of propylthiouracil-induced antineutrophil cytoplasmic antibody associated vasculitis: report of one case and literature review

Objective Propylthiouracil(PTU),a drug commonly used to treat hyperthyroidism,is known to cause antineutrophil cytoplasmic antibody(ANCA)associated vasculitis as a rare complication.We reported one case of pediatric pulmonary hemorrhage as a presentation of ANCA associated vasculitis indued by PTU.Methods The diagnosis was made based on the symptoms,signs,serologic test results and other laboratory examinations.The relevant literatures were reviewed.Results The patient presented with pulmonary hemorrhage,microscopic hematuria,proteinuria,rash and arthralgia,positive antineutrophil cytoplasmic antibody.She had been treated with PTU for 3 years because of Graves disease.After the diagnosis,PTU was withdrawn,and prednisone was applied.After the therapy with prednisone the pulmonary hemorrhage disappeared.Conclusions PTU may induce ANCA associated vasculitis.Withdraw of PTU and introduction of glucocorticoid can improve its prognosis of the disease.