Propylthiouracil-induced Bronchiolitis Obliterans Organizing Pneumonia

Abstract

Propylthiouracil (PTU) is commonly used to treat hyperthyroidism. However, it is also associated with a number of adverse events. In particular, pulmonary complications, although rare, can be serious. Therefore, early detection is paramount. We herein describe a first case of PTU-induced bronchiolitis obliterans organizing pneumonia (BOOP) pathologically confirmed on a surgical lung biopsy. The present case shows that early detection coupled with the immediate withdrawal of PTU can lead to a successful resolution of symptoms and radiographic abnormalities without the need for corticosteroids. Although rare, PTU-induced BOOP should be considered in the differential diagnosis of pulmonary opacity in patients receiving PTU therapy.

Propylthiouracil-induced organizing pneumonia

“…[3,4,6] Other 2 patients only took PTU. [5,7] By contrast, in our presented patient, methimazole was changed to PTU due to the recurrence of hyperthyroidism. Based on these findings, the development of interstitial pneumonia may be not related to the administration of methimazole.…”

“…Two of them were interstitial pneumonitis, [3] 1 had no histological findings, [4] another one was nonspecific interstitial pneumonia [5] and other 2 were bronchiolitis obliterans OP. [6,7] Consequently, the patient we presented is the first reported case of histologically confirmed OP induced by PTU.…”

“…To date, only 6 cases of PTU-induced interstitial pneumonia have been reported. [3–7] Time to onset is from 3 to 120 months. Two of them were interstitial pneumonitis, [3] 1 had no histological findings, [4] another one was nonspecific interstitial pneumonia [5] and other 2 were bronchiolitis obliterans OP.…”

“…Until now, only 6 reported cases of PTU-induced interstitial pneumonia have been reported. [3–7] Here we report another case of PTU-induced organizing pneumonia (OP) and conduct a literature review of the cases of PTU-induced interstitial pneumonia. To our knowledge, this is the first reported case of histologically confirmed OP induced by PTU.…”

Diffuse alveolar haemorrhage secondary to propylthiouracil-induced vasculitis

“…Arthralgia was described in 48% of patients, fever in 37% and skin lesions in 30%. Pulmonary manifestations are less frequent occurring in about 26% of patients and include diffuse alveolar haemorrhage, diffuse interstitial pneumonia, bronchiolitis obliterans with organising pneumonia and adult respiratory distress syndrome 1 7 13 17 19 20 24–29…”