丙硫氧嘧啶致抗中性粒细胞胞浆抗体相关性肺小血管炎  

Case of propylthiouracil-induced antineutropil cytoplasmic antibody-associated pulmonary small-vessel vasculitis

作　　者：王楠[1] 倪江洪[1] 周晓东[1] 谢学建[1] 张征[1] 

机构地区：[1]南京军区南京总医院药品科,南京210002

出　　处：《药物不良反应杂志》2009年第1期56-57,共2页Adverse Drug Reactions Journal

摘　　要：1例48岁男性患者,因甲状腺功能亢进口服丙硫氧嘧啶100mg,1次/d治疗5年余。治疗期间曾出现白细胞降低,给予升白细胞药物治疗,但白细胞仍低于正常水平。近日患者出现干咳、发热、寒战,体温最高达39.6℃。给予青霉素治疗3d仍有发热。胸部CT检查示肺部炎症。先后使用头孢曲松、阿齐霉素治疗,效果不明显。入院后T38.3℃,实验室检查显示:CRP98.0mg/L,ASO505.0U/ml,hs-CRP84.2mg/L,IgG18.9g/L,免疫球蛋白κ轻链16.7g/L,CA125108.9U/ml,抗内皮细胞抗体(AECA)滴度1:10,抗核抗体滴度1:320,抗中性粒细胞胞浆抗体试验呈阳性。考虑为丙硫氧嘧啶所致相关性肺小血管炎。停用丙硫氧嘧啶,静脉给予左氧氟沙星、头孢哌酮-他唑巴坦及口服强的松治疗,3d后患者症状明显改善。A 48-year-old man with hyperthyroidism took propylthiouracil 100 mg once daily for 5 years or more. He developed leukopenia during treatment. Despite treatment with drugs used in leukopenia, his leucocyte level was still lower than the normal range. Recently, the man presented with dry cough, fever, and chill. His body temperature peaked at 39.6℃. Penicillin was administered for 3 days, but his fever remained. A chest CT scan revealed inflammation of the lungs. He was treated successively with eeftriaxone and azithrumycin, but his cough and fever still remained. After admission, his temperature was 38.3℃, and laboratory investigations revealed the following levels： CRP 98.0 mg/L, ASO 505.0 U/ml, high sensitivity CRP 84.2 mg,/ml, IgG 18.9 g/L, immunoglobulin K light chain 16.7 g/L, CA125 108.9 U/ml, anti-endothelial cell antibody （ AECA ） titre 1 ： 10, antinuclear antibody titre 1： 320, His antineutrophil cytoplasmic antibody was positive. Pulmonary small-vessel vasculitis was considered to be propylthiouraeil-assoeiated. The medication was withdrawn. Ⅳlevofloxacin, Ⅳ cefoperazone-tazobactam, and oral prednisone were administered. Three days later, his symptoms markedly improved.

关 键 词：丙硫氧嘧啶 抗中性粒细胞胞浆抗体 肺小血管炎 不良反应 

分 类 号：R595.3[医药卫生—内科学]