Tirotoksikoz ve Perinükleer Antinötrofil Sitoplazmik Antikorla (p-ANCA) İlişkili Vaskülit: Olgu Sunumu

Abstract

Lökositoklastik vaskülit, küçük çaplı damarların tutulduğu bir tablo olup en sık görülen kutane vaskülit formudur. Primer bir hastalık olarak ortaya çıkabildiği gibi bazı ilaçlar, otoimmün hastalıklar ve enfeksiyonlar vaskülit gelişiminden sorumlu olabilir. Palpe edilebilen purpura ve hemorajik veziküllerden oluşan döküntü hastalığın en tipik görünümünü oluşturur. Bu bildiride, biri Graves hastalığının ilk belirtisi olarak ortaya çıkan, diğeri propiltiyourasil (PTU) kullanımına bağlı gelişen ve perinükleer antinötrofil stoplazmik antikor (p-ANCA) pozitifliği saptanan iki lökositoklastik vaskülit olgusu, tablonun tirotoksikoz zemininde farklı etiyolojilerle gelişmesi ve nadir görülmesi nedeniyle sunulmuştur.

Keywords

• Graves hastalığı
• antitiroid ilaçlar
• ANCA
• vaskülit

Thyrotoxicosis and perinuclear antineutrophil cytoplasmic Antibody (p-anca) associated vasculitis: case report

Abstract

Leucocytoclastic vasculitis is the most common form of cutaneous vasculitic syndromes, it occupies the small vessels. It may appear as a primary form or secondary to drugs, autoimmune diseases and infections. Typical findings are skin lesions like palpable purpura and hemorrhagic vesicules. In this paper we reported two patients. One patient had Graves disease presented initially as vasculitic syndrome and the other one had vasculitic lesions under the propylthiouracil treatment. In both cases perinuclear antineutrophilic cytoplasmic antibody (p-ANCA) was detected. We described these rare forms of leucocytoclastic vasculitic syndromes based on thyrotoxicosis linked to different etiologies.

Keywords

• Graves disease
• antithyroid drugs
• vasculitis
• ANCA

References

1. 1. Jennette JC, Falk RJ, Andrassy D, et al. Nomenclature of systemic vasculitides. Proposal of an International Consensus Conference. Arthritis Rheum 1994;37:187-92.
2. 2. Calabrese LH, Michael BA, Bloch DA, et al. The American Collage of Rheumatology, 1990 classification of hypersensitivity vasculitis. Arthritis Rheum 1990;33:1108-18.
3. 3. Fauci AS, Haynes BF, Katz P. The spectrum of vasculitis: Clinical, pathologic, immunologic and therapeutic considerations. Ann Intern Med 1978;89:660-7.
4. 4. Niles JL. Antineutrophil cytoplasmic antibodies in the classification of vasculitis. Annu Rev Med 1996;47:303-13.
5. 5. Hagen E, Daha M, Hermans J, et al. Diagnostic value of standardised assays for antineutrophil cytoplasmic antibodies in idiopathic systemic vasculitis. Kidney Intern 1998;53:743-53.
6. 6. Gunton JE, StielJ, Caterson RJ, et al. Clinical case seminar: anti-thyroid drugs and anti-neutrophil cytoplasmic antibodypositive systemic vasculitis associated with propylthiouracil theraphy: report of 2 children with Graves’ disease. J Med Assoc Thai 2002;85(suppl 4):S1295-302.
7. 7. Kitahara T, Hiromura K, Maezawa A, Ono K, Narahara N, Yano S. Case of propylthiouracil- induced vasculitis associ- ated with anti-neutrophil cytoplasmic antibody (ANCA); review of the literature. Clin Nephrology 1997;47: 336-40.
8. 8. Harper L, Chin L, Daykin J, et al. Propylthiouracil and carbimazole associated-antineutrophil cytoplasmic antibodies (ANCA) in patients with Graves’ disease. Clin Endocrinol 2004;60:671-5.

9. 9. Sato H, Hattori M, Fujieda M. High prevalence of antineutrophil cytoplasmic antibody- positivity in childhood onset Graves’ disease treated with propylthiouracil. J Clin Endocrinol Metab 2000;85:4270-3.