We describe a patient who presented with Wegener's granulomatosis associated with antineutrophil cytoplasmic antibodies (ANCA) directed against proteinase 3 (PR3) with a cytoplasmic immunofluorescence pattern (cANCA), whose ANCA type changed to antimyeloperoxidase antibodies with a perinuclear immunofluorescence pattern (pANCA) when treated with propylthiouracil, and changed back to anti-PR3 antibodies with cANCA after the medication was discontinued. The patient developed flares of vasculitis symptoms associated with rises in either type of ANCA. Tests for antimyeloperoxidase ANCA were repeatedly negative before the drug was started, strongly implicating the drug as the cause of the episode. This case demonstrates that patients with idiopathic ANCA-positive vasculitis may quickly develop a superimposed drug-associated ANCA-positive vasculitis. Iatrogenic vasculitis should be suspected when a patient with idiopathic vasculitis with one type of ANCA develops the other type of ANCA.
Abstract.
A case of adrenal insufficiency secondary to metastatic colonic carcinoma is reported. Because the patient was taking prednisone for an unrelated condition, his initial presentation mimicked isolated aldosterone deficiency with an elevated serum potassium of 8.7 mmol/l. Cortisol deficiency was documented by ACTH testing. The diagnosis of metastatic disease causing adrenal insufficiency was suspected after a computed body scan of the abdomen revealed marked bilateral adrenal enlargement. Adrenal insufficiency secondary to metastatic cancer is reviewed.
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