A case of myeloperoxidase-antineutrophil cytoplasmic antibody-associated pulmonary alveolar hemorrhage caused by propylthiouracil
Masayuki Nakayama Masashi Bando Akira Kobayashi Tatsuya Hosono Akihiro Tsujita Hideaki Yamasawa Shoji Ohno Yukihiko Sugiyama
Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University Hospital
We reported the case of pulmonary alveolar hemorrhage caused by propylthiouracil (PTU) with severe respiratory failure and anemia, who improved with PTU discontinuance and steroid therapy. A 35-year-old woman presented with pyrexia, shortness of breath, and arthralgia. Her chest radiograph and CT showed diffuse ground-glass opacities, and her arterial blood gas analysis revealed severe respiratory failure. Laboratory results included a hemoglobin level of 5.2 g/dl, and a myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) level of 203 EU (normal range <9.0 EU). As bronchoalveolar lavage (BAL) fluid showed fresh blood-like fluid containing hemosiderin-laden macrophages, pulmonary alveolar hemorrhage was diagnosed. Since she had been taking PTU for 4 years, PTU was immediately discontinued. Steroid pulse therapy was performed, followed by oral prednisolone 30 mg per day, and her symptoms and chest radiograph findings rapidly improved. Based on the time-course changes, MPO-ANCA may have been involved in the development of pulmonary alveolar hemorrhage.
propylthiouracil: PTU Myeloperoxidase-antineutrophil cytoplasmic antibody: MPO-ANCA Pulmonary alveolar hemorrhage
Received 平成18年12月4日
JJRS, 45(6): 508-513, 2007