Department of Dermatology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University Shanghai, China.
Int J Dermatol. 2012 Mar;51(3):345-8. doi: 10.1111/j.1365-4632.2011.05135.x.
Propylthiouracil (PTU), one of the mainstays of antithyroid therapy drugs, can lead to antineutrophil cytoplasmic antibody (ANCA) positivity and skin lesions. PTU-induced ANCA-positive vasculitis is rare and even more rare is erythema nodosum.
To report a case of a 57-year-old woman with hyperthyroidism who developed myeloperoxidase (MPO)-ANCA erythema nodosum after PTU treatment for 11 months.
Skin biopsy demonstrated septal panniculitis without vasculitis. PTU-induced ANCA-positive erythema nodosum was made.
With discontinuation of PTU and initiation of thalidomide, skin lesions resolved completely in three weeks, and after three months, the titers of MPO-ANCA and perinuclear-ANCA (p-ANCA) had decreased remarkably. At 14-month follow-up, the patient was asymptomatic, but low levels of ANCA titers persisted.
This report indicated that ANCA positive erythema nodosum could develop following PTU treatment. Thalidomide has been proven to be helpful and averted the adverse effects from systemic corticosteroids and other immunosuppressive drugs in this patient.
丙硫氧嘧啶（PTU）是抗甲状腺治疗药物的主要药物之一，可导致抗中性粒细胞胞质抗体（ANCA）阳性和皮肤损伤。PTU 诱导的 ANCA 阳性血管炎罕见，而结节性红斑更为罕见。
报告一例 57 岁女性甲状腺功能亢进症患者，在接受 PTU 治疗 11 个月后出现髓过氧化物酶（MPO）-ANCA 结节性红斑。
皮肤活检显示间隔性脂膜炎，无血管炎。诊断为 PTU 诱导的 ANCA 阳性结节性红斑。
停用 PTU 并开始使用沙利度胺后，皮肤病变在三周内完全消退，三个月后 MPO-ANCA 和核周型-ANCA（p-ANCA）滴度显著降低。在 14 个月的随访中，患者无症状，但 ANCA 滴度仍处于低水平。
本报告表明，PTU 治疗后可能会出现 ANCA 阳性结节性红斑。沙利度胺已被证明是有效的，并避免了该患者全身皮质类固醇和其他免疫抑制剂的不良反应。
