Tawanwongsri Weeratian, Chayavichitsilp Pamela
Division of Dermatology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Case Rep Dermatol. 2019 Nov 1;11(3):303-309. doi: 10.1159/000503990. eCollection 2019 Sep-Dec.
Major identifiable causes of leukocytoclastic vasculitis include certain infections and medications. Amongst antithyroid drugs, methimazole (MMI) is rarely implicated as a culprit drug. We report the first case, in Thailand, of MMI-induced leukocytoclastic vasculitis in a 41-year-old Thai female who had received MMI for relapsed Graves' disease. MMI was discontinued and cholestyramine at a dose of 4 g four times daily was given instead. Her rashes on both legs resolved dramatically at 1-week follow-up. However, thyroid function test revealed unimproved thyrotoxicosis. She subsequently underwent radioiodine ablation as a definitive treatment. There were neither recurrent skin lesions nor other systemic involvements during the 3-month follow-up period. Notably, the most crucial step in the management of drug-induced leukocytoclastic vasculitis is the discontinuation of the offending drug in order to avoid further progression of the disease. The administration of immunosuppressive agents may not be necessary in patients with mild severity and non-vital organ involvement.
白细胞破碎性血管炎主要可识别的病因包括某些感染和药物。在抗甲状腺药物中，甲巯咪唑（MMI）很少被认为是致病药物。我们报告了泰国首例MMI诱发的白细胞破碎性血管炎病例，患者为一名41岁泰国女性，因Graves病复发接受MMI治疗。停用MMI，改为每日4次、每次4克的消胆胺治疗。1周随访时，她双腿的皮疹显著消退。然而，甲状腺功能检查显示甲状腺毒症未改善。她随后接受放射性碘消融作为确定性治疗。在3个月的随访期内，既无皮肤病变复发，也无其他全身受累情况。值得注意的是，药物诱发的白细胞破碎性血管炎治疗中最关键的步骤是停用致病药物，以避免疾病进一步进展。对于轻度病情且无重要器官受累的患者，可能无需使用免疫抑制剂。
