Propylthiouracil-induced autoimmune syndromes: two distinct clinical presentations with different course and management

Semin Arthritis Rheum. 2006 Aug;36(1):4-9. doi: 10.1016/j.semarthrit.2006.03.003. Epub 2006 Jul 3.


Objectives: To report 4 cases of propythiouracil (PTU)-induced lupus or vasculitis and to review the literature on that subject.

Methods: We describe the clinical presentation, course, and outcome of 4 patients and review the medical literature registered in the Medline PubMed database from 1966 to 2004 by using the keywords: Graves, thyrotoxicosis, propylthiouracil, lupus, vasculitis, arthritis, rash, ANA, and ANCA. Cases were classified into drug-induced lupus (DIL) or vasculitis using accepted definitions and evaluated with emphasis on gender, age, origin, duration of treatment, delay in diagnosis, clinical and serological features, and outcome.

Results: We described our 4 patients and analyzed 42 well-documented cases of DIL- and PTU-induced vasculitis (30 had vasculitis and 12 fulfilled the classification criteria of DIL). Patients with vasculitis were significantly older (mean 43 versus 22 years) and had a longer duration of treatment in comparison with DIL (35 versus 24 weeks). Musculoskeletal symptoms were prominent in DIL, while renal and pulmonary involvement was found in a significantly higher proportion of PTU-induced vasculitis. ANA, anti-DNA, and anti-histone were predominantly found in DIL, while p-ANCA was found in a similar proportion of patients in both groups. c-ANCA was detected only in patients with vasculitis. All patients with DIL completely recovered (most after stopping PTU), while about 50% of PTU-induced vasculitis needed steroids or immunosuppressive drugs, including cyclophosphamide and plasmapheresis.

Conclusions: Most of the cases of PTU-induced autoimmune phenomena are due to vasculitis. Despite the common presence of p-ANCA in both DIL- and PTU-induced vasculitis, substantial differences in demographic, clinical, and outcome features of these entities allow an accurate diagnosis and consequent management.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antithyroid Agents / adverse effects*
  • Female
  • Graves Disease / complications
  • Graves Disease / drug therapy*
  • Graves Disease / physiopathology
  • Humans
  • Lupus Erythematosus, Systemic / chemically induced*
  • Lupus Erythematosus, Systemic / physiopathology
  • Lupus Erythematosus, Systemic / rehabilitation
  • Male
  • Middle Aged
  • Propylthiouracil / adverse effects*
  • Treatment Outcome
  • Vasculitis, Leukocytoclastic, Cutaneous / chemically induced*
  • Vasculitis, Leukocytoclastic, Cutaneous / physiopathology
  • Vasculitis, Leukocytoclastic, Cutaneous / rehabilitation
  • Withholding Treatment


  • Antithyroid Agents
  • Propylthiouracil