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(Chest. 1999;116:1485-1488.)
© 1999 American College of Chest Physicians

Diffuse Alveolar Hemorrhage and Pulmonary Capillaritis Due to Propylthiouracil*

Samjot Singh Dhillon, MD; Digvijay Singh, MD, FCCP; Nathaniel Doe, MD; Alam M. Qadri, MD, FRCP; Santuccio Ricciardi, MD and Marvin I. Schwarz, MD, FCCP

* From the Saint Elizabeth Health Center (Drs. Dhillon, Singh, Doe, Qadri, and Ricciardi), Youngstown, OH; and the Division of Pulmonary and Critical Care (Dr. Schwarz), University of Colorado Health Sciences Center, Denver, CO.

Correspondence to: Samjot Singh Dhillon, MD, Department of Internal Medicine, St. Elizabeth Health Center, 1044 Belmont Ave, Youngstown, OH 44501-1970; e-mail: samjot{at}rocketmail.com

Propylthiouracil (PTU) has recently been observed to be associated with antineutrophil cytoplasmic antibody (ANCA)–positive small vessel vasculitis, resulting in crescentic glomerulonephritis and, infrequently, diffuse alveolar hemorrhage (DAH). We describe a case of a 23-year-old pregnant woman who developed a perinuclear ANCA and antimyeloperoxidase-positive small vessel vasculitis manifesting as DAH and crescentic glomerulonephritis after she began taking PTU. An open lung biopsy was consistent with pulmonary capillaritis. She responded to corticosteroid therapy and discontinuation of PTU. DAH can be caused by pulmonary capillaritis, bland hemorrhage, or diffuse alveolar damage. To our knowledge, this represents the first documentation of an underlying pulmonary capillaritis in a case of PTU-induced DAH.

Key Words: antineutrophil cytoplasmic antibody vasculitis • diffuse alveolar hemorrhage • propylthiouracil • pulmonary capillaritis




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