Cytoplasmic Pattern Anti-neutrophil Cytoplasmic Antibody (cANCA)-positive Cutaneous Leukocytoclastic Vasculitis Induced by Propylthiouracil: A Case Report

Propylthiouracil (PTU) is a medication commonly used to treat hyperthyroidism, but it has various rare side effects such as anti-neutrophil cytoplasmic antibodies (ANCA)- associated vasculitis (AAV). In the last decades, multiple cases of PTU-induced AAV have been reported, some being fatal. While AAV is primarily related to perinuclear-staining ANCA/anti-myeloperoxidase (pANCA/anti-MPO), it can occur to a lesser extent in association with cytoplasmic staining ANCA/ proteinase 3 (cANCA/PR3). A case is presented of a 62-year-old female with a history of hyperthyroidism due to toxic multinodular goiter treated with a standard dose of PTU. Approximately 3 years after starting therapy, she noticed formation of skin ulcerations on both of her ear lobes, nose and bilateral limbs. Detailed hospital work-up detected cANCA positivity. Biopsy of the affected skin revealed leukocytoclastic vasculitis and additional tests excluded systemic vasculitis. The patient was diagnosed as PTU-induced vasculitis, a form of drug-induced vasculitis. Although clinical manifestations improved slightly after total thyroidectomy, the patient could not be saved because of the fulminant course of infected and disseminated skin ulcers. Conclusion: PTU is one of the causes of AAV. However, the presence of cANCA positivity when pANCA is negative in PTU-induced AAV is extremely rare. Here, we present a rather unusual case of PTU-induced AAV associated with cANCA. [Med-Science 2016; 5(2.000): 645-54

Pre-opereative Parathormone Levels are Correlated with Mean Diameter of Parathyroid Adenoma and Pre-operative Serum Calcium and Alkaline Phosphatase Levels

The aim of the present study was to determine the relationship between biochemical parameters, mean diameter of parathyroid adenoma (MDPA) and parathyroid hormone (PTH) levels in patients who underwent parathyroid surgery.Materials and Methods: Data were collected retrospectively from patients with hyperparathyroidism who were operated and followed in our hospital between September 2011 and April 2014. Twenty-nine (male/female = 8/21) patients with a mean age of 58.31 ± 12.59 years were enrolled into the study. The mean pre-operative serum calcium and intact PTH (iPTH) levels were 11.98±1.23 mg/dl and 386.52±374.96 pg/ml, respectively. Serum pre-operative calcium levels were found to be significantly higher in patients who had nephrolithiasis than those who did not, whereas pre-operative serum phosphate levels were lower. Pre-operative iPTH levels were found to be correlated with pre-operative calcium, alkaline phosphatase and MDPA but not with pre-operative serum phosphate. Also, pre-operative calcium levels were found to be significantly correlated with MDPA.Conclusion: Presence of nephrolithiasis is associated with higher pre-operative calcium and lower phosphate levels. Pre-operative iPTH and calcium levels were also found to be significantly correlated with MDPA; this suggests that serum iPTH and calcium levels can be useful in predicting MDPA. [Med-Science 2015; 4(3.000): 2401-13