Journal article
A fatal case of propylthiouracil-induced ANCA-associated vasculitis resulting in rapidly progressive glomerulonephritis, acute hepatic failure, and cerebral angiitis
Clinical nephrology, v 83(5), pp 309-314
01 May 2015
PMID: 25208313
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Introduction: Propylthiouracil (PTU)-induced antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis presenting with renal failure, acute hepatic failure, and cerebral angiitis is a rare yet fatal disease. Early diagnosis and management may help in reducing mortality and morbidity. Plasmapheresis and induction with either cyclophosphamide or rituximab is indicated. Understanding the pathophysiology and complex management of this disease poses challenges to clinicians. Case report: A 42-year-old woman presented with acute renal and hepatic failure. She had been on PTU for 11 months for Graves' disease. Initial urine microscopy showed red blood cell casts. Anti PR-3 antibodies were positive. Kidney biopsy revealed pauci-immune glomerulonephritis with crescent formation. Renal and hepatic failures were attributed to PTU-induced c-ANCA production as other serological workup was negative. Pulse steroids and plasmapheresis were initiated. Later she developed pneumonia. She was also given rituximab. After the first dose of rituximab, plasmapheresis was held for 3 days. The second dose of rituximab was given in 5 days owing to removal by plasmapheresis. She got 8 sessions of plasmapheresis. She also developed seizures and MRA of her head revealed cerebral infarct, with findings suggestive of cerebral angiitis. She did not recover and expired 20 days after presentation. Conclusion: PTU can cause ANCA-associated vasculitis resulting in multiorgan failure. Plasmapheresis should be held for 3 days after rituximab infusion in order to allow maximum exposure. The second dose of rituximab may be given before the recommended 7-day interval in cases in which plasmapheresis is being performed to maximize therapeutic benefit.
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Details
- Title
- A fatal case of propylthiouracil-induced ANCA-associated vasculitis resulting in rapidly progressive glomerulonephritis, acute hepatic failure, and cerebral angiitis
- Creators
- Talal Ali Khan - Drexel Univ, Coll Med, Div Nephrol, Philadelphia, PA 19104 USAFrancis Cheuk Yin Luk - Drexel Univ, Coll Med, Div Rheumatol, Philadelphia, PA 19104 USAHakim Taalib Uqdah - Drexel Univ, Coll Med, Dept Internal Med, Philadelphia, PA 19104 USAAzka Arif - Drexel Univ, Coll Med, Div Nephrol, Philadelphia, PA 19104 USAHumira Hussain - Drexel Univ, Coll Med, Div Rheumatol, Philadelphia, PA 19104 USAArundathi Jayatilleke - Drexel Univ, Coll Med, Div Rheumatol, Philadelphia, PA 19104 USASandeep Aggarwal - Drexel Univ, Coll Med, Div Nephrol, Philadelphia, PA 19104 USAShaili Aggarwal - Pharmacology and Physiology
- Publication Details
- Clinical nephrology, v 83(5), pp 309-314
- Publisher
- Dustri-Verlag Dr Karl Feistle
- Number of pages
- 6
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Pharmacology and Physiology
- Web of Science ID
- WOS:000358414500009
- Scopus ID
- 2-s2.0-84940048115
- Other Identifier
- 991019173668304721
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Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Urology & Nephrology