Next Article in Journal
Mortality Prediction Utilizing Blood Biomarkers to Predict the Severity of COVID-19 Using Machine Learning Technique
Previous Article in Journal
Impaired Ciliary Beat Frequency and Ciliogenesis Alteration during Airway Epithelial Cell Differentiation in COPD
Case Report

Methimazole-Induced ANCA Vasculitis: A Case Report

1
Nephrology Division, School of Medicine, University of São Paulo, São Paulo 01246-903, SP, Brazil
2
Nephrology and Dialysis Service, Oswaldo Cruz German Hospital, São Paulo 01323-020, SP, Brazil
3
Pathology Division, School of Medicine, University of São Paulo, São Paulo 01246-903, SP, Brazil
*
Author to whom correspondence should be addressed.
Academic Editors: Jean-Paul P. M. De Vries and Gino Seravalle Seravalle
Diagnostics 2021, 11(9), 1580; https://doi.org/10.3390/diagnostics11091580
Received: 12 July 2021 / Revised: 15 August 2021 / Accepted: 17 August 2021 / Published: 31 August 2021
(This article belongs to the Section Pathology and Molecular Diagnostics)
Rapidly progressive glomerulonephritis (RPGN) is a syndrome which presents rapid loss of renal function. Vasculitis represents one of the major causes, often related to anti-neutrophil cytoplasmic antibodies (ANCA). Herein, we report a case of methimazole-induced ANCA-associated vasculitis. A 35-year-old woman complained of weight loss and fatigue for 2 weeks and attended the emergency room with alveolar hemorrhage. She had been diagnosed with Graves’ disease and had been taking methimazole in the past 6 months. Her physical examination showed pulmonary wheezing, hypertension and signs of respiratory failure. Laboratory tests revealed urea 72 mg/dL, creatinine 2.65 mg/dL (eGFR CKD-EPI: 20 mL/min/1.73 m2), urine analysis with >100 red blood cells per high-power field, 24 h-proteinuria: 1.3 g, hemoglobin 6.6 g/dL, white-cell count 7700/mm3, platelets 238,000/mm3, complement within the normal range, negative viral serological tests and ANCA positive 1:80 myeloperoxidase pattern. Chest tomography showed bilateral and diffuse ground-glass opacities, and bronchial washing confirming alveolar hemorrhage. A renal biopsy using light microscopy identified 27 glomeruli (11 with cellular crescentic lesions), focal disruption in glomerular basement membrane and fibrinoid necrosis areas, tubulitis and mild interstitial fibrosis. Immunofluorescence microscopy showed IgG +2/+3, C3 +3/+3 and Fibrinogen +3/+3 in fibrinoid necrosis sites. She was subsequently diagnosed with crescentic pauci-immune glomerulonephritis, mixed class, in the setting of a methimazole-induced ANCA vasculitis. The patient was treated with methimazole withdrawal and immunosuppressed with steroids and cyclophosphamide. Four years after the initial diagnosis, she is currently being treated with azathioprine, and her exams show creatinine 1.30 mg/dL (eGFR CKD-EPI: 52 mL/min/1.73 m2) and negative p-ANCA. View Full-Text
Keywords: ANCA; ANCA associated vasculitis; crescentic glomerulonephritis; vasculitis; alveolar hemorrhage; methimazole; antithyroid drugs; immunosuppression therapy ANCA; ANCA associated vasculitis; crescentic glomerulonephritis; vasculitis; alveolar hemorrhage; methimazole; antithyroid drugs; immunosuppression therapy
Show Figures

Figure 1

MDPI and ACS Style

Neves, P.D.M.d.M.; Mota, L.B.; Dias, C.B.; Yu, L.; Woronik, V.; Cavalcante, L.B.; Malheiros, D.M.A.C.; Jorge, L.B. Methimazole-Induced ANCA Vasculitis: A Case Report. Diagnostics 2021, 11, 1580. https://doi.org/10.3390/diagnostics11091580

AMA Style

Neves PDMdM, Mota LB, Dias CB, Yu L, Woronik V, Cavalcante LB, Malheiros DMAC, Jorge LB. Methimazole-Induced ANCA Vasculitis: A Case Report. Diagnostics. 2021; 11(9):1580. https://doi.org/10.3390/diagnostics11091580

Chicago/Turabian Style

Neves, Precil D.M.d.M., Lucas B. Mota, Cristiane B. Dias, Luis Yu, Viktoria Woronik, Lívia B. Cavalcante, Denise M.A.C. Malheiros, and Lectícia B. Jorge. 2021. "Methimazole-Induced ANCA Vasculitis: A Case Report" Diagnostics 11, no. 9: 1580. https://doi.org/10.3390/diagnostics11091580

Find Other Styles
Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Article Access Map by Country/Region

1
Back to TopTop