Carbimazole-induced lupus

We describe the case of a 50-year-old lady admitted with a 3-week history of dyspnoea and left-sided pleuritic pain associated with pleural effusion. This common clinical picture nevertheless gave rise to a significant diagnostic challenge. The medical history included a diagnosis of thyrotoxicosis...

Full description

Saved in:
Bibliographic Details
Published in:BMJ case reports 2013-02, Vol.2013, p.bcr2012007596
Main Authors: Haq, Ihteshamul, Sosin, Michael D, Wharton, Simon, Gupta, Anindya
Format: Article
Language:English
Subjects:
Abdomen
Antithyroid Agents - adverse effects
Blood clots
Carbimazole - adverse effects
Drugs
Female
Humans
Hyperthyroidism
Lupus
Lupus Erythematosus, Systemic - chemically induced
Metabolites
Middle Aged
Pain
Patients
Pleural effusion
Proteins
Thyrotoxicosis - drug therapy
Ultrasonic imaging
Unexpected Outcome (Positive or Negative) Including Adverse Drug Reactions
United Kingdom
White
White people
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:We describe the case of a 50-year-old lady admitted with a 3-week history of dyspnoea and left-sided pleuritic pain associated with pleural effusion. This common clinical picture nevertheless gave rise to a significant diagnostic challenge. The medical history included a diagnosis of thyrotoxicosis made 6 months previously that was being treated with carbimazole by her general practitioner. Key-investigation results were as follows: (1) pleural fluid was sterile and exudative, with no malignant cells, (2) erythrocyte sedimentation rate, C reactive protein and D-dimer were raised, (3) antinuclear antibody, anti-dsDNA and antihistone antibodies were newly positive, (4) imaging revealed a large left ventricular mass consistent with thrombus in the absence of evidence of a myocardial infarction. Based on the above investigations we hypothesised that carbimazole had induced systemic lupus erythematosus, manifesting as serositis resulting in an exudative pleural effusion and a proinflammatory/prothrombotic state. Carbimazole was stopped. The patient's pleural effusion completely resolved and she remains asymptomatic.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2012-007596