Hypertrophic Pachymeningitis Associated with Myeloperoxidase-anti-neutrophil Cytoplasmic Antibodies Induced by Propylthiouracil

A 71-year-old man with hyperthyroidism complained of headache lasting two months. He had been using propylthiouracil (PTU) for 14 years. Treatment intensification did not improve the symptoms. Blood tests detected a positive myeloperoxidase-anti-neutrophil cytoplasmic antibody (MPO-ANCA). Diffuse du...

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Bibliographic Details
Published in:Internal Medicine 2023/07/01, Vol.62(13), pp.1951-1955
Main Authors: Koide, Sakiho, Kitajima, Kouhei, Yamazaki, Masanori, Ichikawa, Takanori, Komatsu, Mitsuhisa
Format: Article
Language:English
Subjects:
Aged
ANCA-associated vasculitis
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - chemically induced
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - diagnosis
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - drug therapy
Antibodies, Antineutrophil Cytoplasmic
Antineutrophil cytoplasmic antibodies
Antithyroid Agents - adverse effects
Case Report
Graves' disease
Headache
Humans
Hyperthyroidism
hypertrophic pachymeningitis
Hypertrophy - complications
Internal medicine
Leukocytes (neutrophilic)
Magnetic resonance imaging
Male
Meningitis - chemically induced
Meningitis - diagnosis
Meningitis - drug therapy
Methotrexate
Methylprednisolone
Peroxidase
Prednisolone
Propylthiouracil
Propylthiouracil - adverse effects
refractory headache
Vasculitis
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Summary:A 71-year-old man with hyperthyroidism complained of headache lasting two months. He had been using propylthiouracil (PTU) for 14 years. Treatment intensification did not improve the symptoms. Blood tests detected a positive myeloperoxidase-anti-neutrophil cytoplasmic antibody (MPO-ANCA). Diffuse dural thickening was identified by magnetic resonance imaging. The patient was diagnosed with hypertrophic pachymeningitis (HP) due to ANCA-associated vasculitis (AAV). He received methylprednisolone pulse therapy followed by prednisolone and methotrexate, which improved his headache. PTU-induced AAV-related HP is a rare and indiscernible disease. Therefore, the possibility of the disease should be proactively considered when a PTU user experiences refractory headaches.
ISSN:0918-2918
1349-7235
DOI:10.2169/internalmedicine.0692-22