Propylthiouracil-Induced Lupus, Antiphospholipid Syndrome, and Stroke in a Patient With Graves Hyperthyroidism

Ortiz GA, Lagari-Libhaber V, Prieto-Sanchez L, et al. — Thu, 01 Dec 2011 00:00:00 GMT

Objective

To describe a case of propylthiouracil-induced lupus, complicated with antiphospholipid syndrome and acute ischemic stroke.

Design

Case report.

Setting

Academic medical center.

Patient

A 27-year-old man with a diagnosis of Graves disease developed multiple ischemic strokes 2 weeks after starting treatment with propylthiouracil. Thyrotoxicosis and abnormal hypercoagulable and rheumatological profiles were remarkable, with prolonged partial thromboplastin time, elevated anticardiolipin antibody level, and positive antinuclear antibody, lupus anticoagulant, Sjögren antibody, and anti–double-stranded DNA antibody test results, which were more than 8-fold greater than normal values. No clinical manifestations of systemic lupus erythematosus were present.

Intervention

Discontinuation of propylthiouracil and treatment with radioactive iodine.

Results

Hyperthyroidism resolved and anti–double-stranded DNA antibodies returned to normal levels. Eventually, antiphospholipid syndrome was diagnosed. He was treated with oral anticoagulation and remained asymptomatic for 1 year of follow-up.

Conclusion

In this young man with Graves hyperthyroidism, treatment with propylthiouracil was associated with transient autoimmune reactions suggestive of drug-induced lupus, antiphospholipid syndrome, and acute ischemic stroke.

JAMA Neurology: Hyperthyroidism Topic Collection

Propylthiouracil-Induced Lupus, Antiphospholipid Syndrome, and Stroke in a Patient With Graves Hyperthyroidism