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
Tables
Lab and normal range | Baseline | On hospital admission |
---|---|---|
H: high. | ||
Creatinine (0.66 - 1.25 mg/dL) | 0.84 | 21.9 (H) |
BUN (6 - 20 mg/dL) | 10 | 28 (H) |
Urine analysis | ||
Protein (trace) (10 - 20 mg/dL) | Trace | 3+ (H) |
WBC (0 - 5/hpf) | 0 - 5 | 26 - 50 (H) |
RBC (0 - 2/hpf) | 0 - 2 | 3 - 5 (H) |
Lab and normal range | On 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) |
Case number | 1 [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 rash | Yes | Yes | No |
ANCA positivity | No | No | No |
ANA positivity | No | N/A | Yes |
Anti-dsDNA positivity | No | N/A | No |
Anti-glomerular basement membrane positivity | N/A | No | No |
Serum cryoglobulin | N/A | Yes | No |
Hepatitis C | N/A | No | No |
C3 levels | N/A | Low | Low |
C4 levels | N/A | Low | WNL |
Other findings | CRP 23.7 (H) ESR WNL | 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) |
Case number | 1 | 2 | 3 |
---|---|---|---|
HD: hemodialysis; MMI: methimazole. | |||
Author | Kanat et al [8] | Day et al [9] | Present case |
Patient age (years)/sex | 56/M | 72/M | 27/M |
Etiology of underlying hyperthyroidism | Unspecified | Unspecified | Graves’ disease |
Medication dosage/duration | MMI 20 mg daily/1 week | Carbimazole 20 mg daily/2 weeks | MMI 10 mg daily/6 months |
Biopsy findings | 1) Cutaneous leukocytoclastic vasculitis | 1) Cutaneous leukocytoclastic vasculitis 2) Interstitial nephritis w/eosinophils | 1) Chronic tubulointerstitial nephritis w/crescentic changes |
Cessation of offending drug and commencement of steroids | Yes | Yes | Yes |
Thyroidectomy | No | No | Yes |
Outcome | 1) Cutaneous rashes resolved | 1) Cutaneous rash improved 2) HD dependent | 1) Pleural effusions resolved 2) HD dependent |