Endocrine Abstracts

Introduction: Anti-neutrophil cytoplasmic antibodies (ANCA) associated vasculitis drugs induced are a rare side effect of antithyroid drugs. It is more commonly associated with propylthiouracil (PTU). The clinical manifestations are polymorphic like in primary vasculitides, but less severe; ranging from less specifics syndromes to multiple organs injured and lifethreatening in rare case. Cardiac involvement is uncommon. Herby we present the first case report of a 25-yr-old woman wich developed a syndrome of pericarditis as the first sign of ANCA associated vasulitis induced by methimazol.

Observation: A 25-yr-old woman was admitted with a recent history of dyspnea. A Graves’ hyperthyroidism was diagnosed 1 year before; she was clinically and biochemically euthyroid on Methimazol 20 mg daily 1 year before. The examination revealed blood pressure of 120/60 mmHg, pericardial rub, and no edema. GFR > 60 ml/min/1.73m, and systemic/urine sediment showed no abnormalities. The chest radiography showed severe cardiomegaly. An echocardiography showed a moderate-to-severe pericardial effusion. Direct Coombs test was negative, C3 and C4 within the normal range, ANA was negative, ANCA was positive (1/300), with a p-ANCA pattern. Cryoglobulinemia was negative. Treatment was started with doses of steroids at 1mg/kg/day, and the patient’s state start to improve considerably. Two days after her admission, she developped necrotic-looking vasculitic skin lesions on bilateral lower extremity and on her right ear. Skin biopsy showed leukocytoclastic vasculitis. The methimazol induced vascularitis was suspected, so we stopped the offending treatment. In her follow up, we noticed a progressively disappearance of the skin lesions and pericardial effusion. In the light of clinical and laboratory findings she was diagnosed leukocytoclastic vasculitis caused by MMI, with positive p-ANCA.

Conclusion: The importance of this case is to call attention to the possible occurrence of pericarditis as a first symptom of methimazol-induced ANCA vascullitis.