Background: Thiamazole (Methimazole) is one of the antithyroid drugs (ATDs) that are the most commonly used as first-line therapy in the treatment of thyrotoxicosis due to Graves’ disease and toxic nodular goitre in Tunisia. Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) constitutes a group of rare diseases characterised by autoimmune-associated inflammation and vessel damage. AAV can be induced by ATDs, with PTU being more commonly associated with the condition, though it often remains misdiagnosed. Cardiac involvement, particularly pericardial effusion, is uncommon in these cases.
Case Report: This chapter reports a case of a 25-year-old
woman who had a history of Graves’ disease treated by Methimazole (MMI) 20 mg
daily for one year. She was admitted because of pericardial effusion. Two days
later, necrotic-looking vasculitic skin lesions appeared. Anti-neutrophil
cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) was confirmed by
serum test and skin biopsy. The MMI was suspected to be the culprit and was
immediately withdrawn. She progressively improves her symptoms, and her skin
lesions and pericardial effusion were resolved.
Conclusion: Although the association between PTU and AAV is
well-documented, less than 1 of 6 ANCA-positive patients treated with ATDs
developed AAV. This is the first case report of pericarditis as the first sign
of AAV induced by Methimazole. The withdrawal of the offending medication is
the fundamental pillar of the therapeutic approach to avoid more severe
complications.
Author(s) Details
Manel Jemel
Department of Endocrinology, National Institute of Nutrition, Tunis,
Tunisia and Manar Tunis University, Tunisia.
Hanen Sayad
Department of Endocrinology, Fattouma Bourguiba University Hospital, Monastir,
Tunisia.
Ines Khochtali
Department of Endocrinology, Fattouma Bourguiba University Hospital,
Monastir, Tunisia.
Please see the book here :- https://doi.org/10.9734/bpi/msup/v4/6656
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