DOI: 10.12890/2026_006500

From thyroid therapy to systemic crisis: PTU-induced c-ANCA vasculitis accompanied by cold-agglutinin disease and organ failure

Authors

  • Pelagia Kefala-Karli Paphos General Hospital, State Health Organization Services, Paphos, Cyprus
  • Theodosia Christou Paphos General Hospital, State Health Organization Services, Paphos, Cyprus
  • Elisavet Georgiou Paphos General Hospital, State Health Organization Services, Paphos, Cyprus
  • Despina Pavlou Paphos General Hospital, State Health Organization Services, Paphos, Cyprus
  • Andreas Kapouralos Paphos General Hospital, State Health Organization Services, Paphos, Cyprus
  • Kyriakos Panagi Paphos General Hospital, State Health Organization Services, Paphos, Cyprus
  • Konstantina Chalmoukou Paphos General Hospital, State Health Organization Services, Paphos, Cyprus

chalmkon@gmail.com

Keywords

Propylthiouracil, vasculitis, acute renal failure, c-ANCA, cold agglutinin disease

Abstract

Introduction: Propylthiouracil (PTU) is typically used as first line therapy for hyperthyroidism but is associated with a spectrum of adverse effects including vasculitis, that may lead to acute renal failure and exceptionally to pancreatitis, represents the most severe.
Case description: Here we present the case of a 43-year-old woman with a history of Graves’ disease until recently on PTU therapy, who presented with fever and myalgia complicated by cold agglutinin disease, acute renal failure and pancreatitis. Subsequent laboratory studies and thorough physical examination excluding other causes revealed the presence of antibodies against leukocyte proteinase 3. Prompt initiation of immunosuppressive therapy and plasmapheresis led to immediate improvement of the patient’s clinical condition and laboratory tests.
Conclusion: Clinicians should maintain a high index of suspicion for autoimmune phenomena in patients receiving PTU even after cessation of the medication. Early recognition, immediate discontinuation of the drug, and timely initiation of immunosuppressive therapy are essential to prevent irreversible organ damage.

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Published

2026-04-22

Issue

Vol. 13 No. 5 (2026)

Categories

How to Cite

1.
Kefala-Karli P, Christou T, Georgiou E, Pavlou D, Kapouralos A, Panagi K, et al. From thyroid therapy to systemic crisis: PTU-induced c-ANCA vasculitis accompanied by cold-agglutinin disease and organ failure. EJCRIM [Internet]. 2026 Apr. 22 [cited 2026 Nov. 3];13(5). Available from: https://ejcrim.com/index.php/ejcrim/article/view/6500