Carbimazole-induced lupus

BMJ Case Rep. 2013 Feb 6:2013:bcr2012007596. doi: 10.1136/bcr-2012-007596.

Abstract

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.

Publication types

  • Case Reports

MeSH terms

  • Antithyroid Agents / adverse effects*
  • Carbimazole / adverse effects*
  • Female
  • Humans
  • Lupus Erythematosus, Systemic / chemically induced*
  • Middle Aged
  • Thyrotoxicosis / drug therapy

Substances

  • Antithyroid Agents
  • Carbimazole