Propylthiouracil‐induced vasculitic oral ulcers with anti‐neutrophil cytoplasmic antibody

Abstract

Isotretinoin is frequently prescribed for acne. We suggest that isotretinoin may be a cause of urticaria and/or angioedema in patients using this agent. References1 Ellis CN, Krach KJ. Uses and complications of isotretinoin therapy. J Am Acad Dermatol 2001; 45: S150-S157. 2 De Raeve L, Willemsen M, De Coninck A, Roseeuw D. Paronychia and the formation of granulation tissue during isotretinoin therapy. Dermatologica 1986; 172: 278-280. 3 Önder M, Öztas MO, Öztas P. Isotretinoin-induced nail fragility and onycholysis. J Dermatol Treat 2001; 12: 115-116. 4 Zachariae H. Delayed wound healing and keloid formation following argon laser treatment or dermabrasion during isotretinoin treatment. Br J Dermatol 1988; 118: 703-706. 5

Propylthiouracil-Induced Vasculitis With Antineutrophil Cytoplasmic Antibody

“…[1][2][3] It can produce a wide range of adverse reactions, usually occurring within the first 1 to 3 months of therapy, observed in about 1% to 5% of patients. 4,5 Typical side effects of PTU include gastric intolerance, loss of taste, arthralgia, and mucocutaneous findings such as maculopapular eruptions, urticaria, generalized pruritus, alopecia, angioedema, rosacea, acne-like eruptions, and photosensitivity. Cholestatic hepatitis, hepatocellular necrosis, agranulocytosis, and vasculitis are rare but serious complications.…”

“…Cholestatic hepatitis, hepatocellular necrosis, agranulocytosis, and vasculitis are rare but serious complications. [1][2][3][4][5] We describe a patient with perinuclear antineutrophil cytoplasmic antibody (p-ANCA)-associated vasculitis while being treated with PTU for Grave's disease.…”

“…Cholestatic hepatitis, hepatocellular necrosis, agranulocytosis, and vasculitis are rare but serious complications. 1-5…”

Can propylthiouracil induce autoimmune-related immunotoxicity?

“…It acts as an inhibitor of thyroid hormones synthesis by competitive inhibition of the enzyme peroxidase and conversion of thyroxine (T4) to triiodothyronine (T3) (1)(2)(3). Even though systemic complications like gastric intolerance, pruritus, arthralgia can be found in only about 1% to 5% of patients, severe complications like agranulocytosis and vasculitis have also been identified (1)(2)(3)(4). Patients with autoimmune thyroid diseases may have other autoimmune conditions and are more prone to the development of druginduced autoimmune diseases.…”