Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access
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Case Report

Volume 8, Number 2-3, May 2018, pages 47-51

Non-Anti-Neutrophil Anti-Cytoplasmic Antibodies Associated Methimazole-Induced Nephritis: Case and Review of Literature


Figure 1.
Figure 1. Representative images from the kidney biopsy demonstrate glomerular crescents. (a) An epithelial crescent is seen in the lower half of the glomerular area (H&E stain). (b) The PAS stain highlights the glomerular tufts and the Bowman’s capsule. The urinary space between these structures contains an epithelial crescent (asterisks). (c) The Jones silver stain highlights an organizing crescent (fibro-epithelial crescent) in the left and lower glomerular areas. The glomerular tufts appear compressed.


Table 1. Significant Lab Values on Admission Compared to Baseline
Lab and normal rangeBaselineOn hospital admission
H: high.
Creatinine (0.66 - 1.25 mg/dL)0.8421.9 (H)
BUN (6 - 20 mg/dL)1028 (H)
Urine analysis
  Protein (trace) (10 - 20 mg/dL)Trace3+ (H)
  WBC (0 - 5/hpf)0 - 526 - 50 (H)
  RBC (0 - 2/hpf)0 - 23 - 5 (H)


Table 2. Significant Lab Values on Admission With No Baseline Comparison
Lab and normal rangeOn hospital admission
H: high.
SSA AB (0 - 0.9 ZZ)> 8.0 (H)
SSB AB (0 - 0.9 ZZ)> 8.0 (H)
TSH (0.47 - 4.68 mIU/L)0.005 (L)
Free thyroxine (0.7 - 1.9 ng/dL)2.41 (H)
Total T4 (5.1 - 13.8 µg/dL)7.5
Urea (9 - 20 mg/dL)211 (H)
C-reactive protein (0 - 10 mg/dL)11 (H)
CRP high sensitivity (< 3.00 mg/L)> 15.00 (H)
Erythrocyte sedimentation rate (0 - 15 mm/h)119 (H)
LDH (313 - 618 units/L)778 (H)
Amylase (48 - 133 units/L)269 (H)
Lipase (23 - 300 units/L)402 (H)
C3 (90 - 165 mg/dL)85 (L)
C4 (10 - 40 mg/dL)28
Total complement CH50 (42 - 62 U/mL)66 (H)
Histopathological IgG4 plasma cells (> 10/hpf)19 (H)
Gamma globulin fraction (0.4 - 1.6 g/dL)2.0 (H)


Table 3. A Comparison of Findings Among the Three Papers
Case number1 [8]2 [9]Present case
ANA: anti-neutrophil; ANCA: anti-neutrophil anti-cytoplasmic antibodies; C: complement; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; N/A: presence or absence of finding not specified.
Presence of rashYesYesNo
ANCA positivityNoNoNo
ANA positivityNoN/AYes
Anti-dsDNA positivityNoN/ANo
Anti-glomerular basement membrane positivityN/ANoNo
Serum cryoglobulinN/AYesNo
Hepatitis CN/ANoNo
C3 levelsN/ALowLow
C4 levelsN/ALowWNL
Other findingsCRP 23.7 (H)
CRP 114 mg/L (H)
ESR 25 mm/h (H)
Creatinine 6.32 mg/dL (H)
CRP 14 mg/L (H)
ESR 119 mm/h (H)
Creatinine 21.9 mg/dL (H)
SSA/SSB negative
IgG4 plasma cells 19/hpf (H)


Table 4. Summary of Causes and Outcomes of Vasculitis or Interstitial Nephritis Induced by Methimazole or Its Pro-Drug Form Carbimazole in Reported Cases
Case number123
HD: hemodialysis; MMI: methimazole.
AuthorKanat et al [8]Day et al [9]Present case
Patient age (years)/sex56/M72/M27/M
Etiology of underlying hyperthyroidismUnspecifiedUnspecifiedGraves’ disease
Medication dosage/durationMMI 20 mg daily/1 weekCarbimazole 20 mg daily/2 weeksMMI 10 mg daily/6 months
Biopsy findings1) Cutaneous leukocytoclastic vasculitis1) Cutaneous leukocytoclastic vasculitis
2) Interstitial nephritis w/eosinophils
1) Chronic tubulointerstitial nephritis w/crescentic changes
Cessation of offending drug and commencement of steroidsYesYesYes
Outcome1) Cutaneous rashes resolved1) Cutaneous rash improved
2) HD dependent
1) Pleural effusions resolved
2) HD dependent