Gaspar-da-Costa Pedro, Duarte Silva Filipa, Henriques Júlia, do Vale Sónia, Braz Sandra, Meneses Santos João, M M Victorino Rui
Serviço de Medicina 2, Hospital de Santa Maria - Centro Hospitalar Lisboa Norte, Avenida Prof. Egas Moniz, 1649-035, Lisbon, Portugal.
Serviço de Endocrinologia, Hospital de Santa Maria - Centro Hospitalar Lisboa Norte, Avenida Prof. Egas Moniz, 1649-035, Lisbon, Portugal.
BMC Pharmacol Toxicol. 2017 Mar 21;18(1):16. doi: 10.1186/s40360-017-0121-1.
Adverse reactions associated to anti-thyroid drugs include fever, rash, arthralgia, agranulocytosis and hepatitis that are thought to be hypersensitivity reactions. Five cases of pleural effusion associated to thionamides have also been reported, two with propylthiouracil and three with carbimazole.
We report here a case of a 75-year-old man admitted because of unilateral pleural effusion. The patient had a recent diagnosis of hyperthyroidism and 6 days after starting methimazole complained of pleuritic chest pain. He had elevated C-reactive protein and erythrocyte sedimentation rate and normal white blood cell count and liver enzymes. Chest radiography showed a moderate right pleural effusion and the ultrasound revealed a loculated effusion that was shown to be an eosinophilic exudate.
The temporal relationship between methimazole intake and the development of pleural effusion combined with the extensive exclusion of alternative causes, namely infectious, neoplastic and primary auto-immune diseases, led to the diagnosis of hypersensitivity reaction to methimazole. The thionamide was stopped and corticosteroid was started with complete resolution of the pleural effusion in 3 months. Awareness of this rare adverse reaction of anti-thyroid drugs is important and methimazole can be added to the list of possible etiologies of drug-induced eosinophilic pleural effusion.
抗甲状腺药物相关的不良反应包括发热、皮疹、关节痛、粒细胞缺乏症和肝炎，这些被认为是过敏反应。也有5例与硫代酰胺相关的胸腔积液的报道，其中2例与丙硫氧嘧啶有关，3例与卡比马唑有关。
我们在此报告一例75岁男性因单侧胸腔积液入院。该患者近期诊断为甲状腺功能亢进，在开始服用甲巯咪唑6天后出现胸膜炎性胸痛。他的C反应蛋白和红细胞沉降率升高，白细胞计数和肝酶正常。胸部X线显示右侧中度胸腔积液，超声显示有分隔的积液，为嗜酸性渗出液。
服用甲巯咪唑与胸腔积液发生之间的时间关系，以及对其他原因（即感染性、肿瘤性和原发性自身免疫性疾病）的广泛排除，导致诊断为对甲巯咪唑的过敏反应。停用硫代酰胺并开始使用皮质类固醇，3个月后胸腔积液完全消退。认识到抗甲状腺药物的这种罕见不良反应很重要，甲巯咪唑可被列入药物性嗜酸性胸腔积液可能的病因清单中。
