Propylthiouracil induced leukocytoclastic vasculitis: A rare manifestation
48 years old female patient was admitted to our endocrinology clinic with the complaints of palpitations, sweating, heat intolerance andskin lesions. We learned that hyperthyroidism was detected eightyears ago, she used antithyroid drug (patient cannot remember the name of drug) for twoyears, thyroidectomy was recommended and the patient did not continue her follow-ups because of fear of the surgery, she did not receive any antithyroid treatment for sixyears. Finally she referred to the internal medicine clinic andpropylthiouracil 50 mg (3 × 1) therapy started. Skin lesions were occurred in the 15th day of the treatment. Large numbers of necrotic-looking vasculitic skin lesions were revealed on her right ear, chest, bilateral lower extremity and abdomen []. WBC: 3.7 K/uL, Neu: 1.3 K/uL, Hgb: 12.1 g/dl, Plt: 251 K/uL, TSH: 0.0059 mIU/ml, T4: 13.97 pmol/L, T3: 5.79 pmol/L, Sedimentation: 45 mm/h, CRP: 109.5 mg/L was detected on his blood analysis. The patient's other routine blood chemistry andcomplete urinalyses were normal. Hepatitis markers were negative. ANA (-), p-ANCA (+), c-ANCA (-) were detected. We suspected PTU-induced vasculitis and PTU treatment was stopped. Skin biopsy was performed because of skin lesions. It was reported as leukocytoclastic vasculitis. Thyroid gland size and its blood supply were increased and no nodule formation was observed in the Doppler ultrasound. Thyroid uptake was calculated as 8.7%. Thyroid scintigraphy was accordance with Graves’ Disease. Vasculitic lesions began to improve after stopping PTU treatment. In the light of clinical and laboratory findings she was diagnosed leukocytoclasticvasculitis caused by PTU, with positive p-ANCA. Radioactive iodine treatment was performed as permanent antithyroid treatment. Skin lesions completely disappeared in her follow up.