Pericarditis: uncommon onset of anti-neutrophil cytoplasmic antibody-associated vasculitis induced by methimazol

Abstract

Anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) can be induced by antithyroid drugs (ATDs). It is more commonly associated with propylthiouracil (PTU) but remains misdiagnosed. The cardiac involvement is uncommon. Case report: we report a case of 25-year-old women who had a history of Graves' disease treated by Methimazole (MMI) 20 mg daily during one year. She was admitted because of pericardial effusion. Two days after, necrotic-looking vasculitic skin lesions appeared. Anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) was confirmed by serum test and skin biopsy. The MMI was suspected to be the culprit and was immediately withdrawn. She progressively improves her symptoms, and her skin lesions and pericardial effusion were resolved. Conclusion: This is the first case report of pericarditis as the first sign AAV induced by Methimazole. The withdrawal of the offending medication is the fundamental pillar of the therapeutic approach to avoid more severe complications.