ABSTRACT
INTRODUCTION: Propylthiouracil (PTU) is a synthetic antithyroid drug that can induce ANCA-associated vasculitis. OBSERVATION: A 27-year-old woman diagnosed with Graves' disease was on PTU for the past 10 years. She developed purpuric lesions of the legs and on the tip of the nose diagnosed as vasculitis. ANCAs were positive, with anti-MPO and anti-PR3 on blood ELISA. After discontinuation of PTU, she was able to fully recover. CONCLUSION: All synthetic antithyroid drugs can induce ANCA-associated vasculitis, more often PTU. In most cases, antibodies are directed against MPO. Dual anti-MPO and anti-PR3 positivity is possible, but rare. The mechanism could be through an accumulation of PTU in neutrophils, altering the structure of MPO and making it immunogenic. PTU can also induce ANCA-free or lupus vasculitis, maculopapular rashes or urticaria. Many other drugs can induce ANCA-associated vasculitis.
Subject(s)
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis , Hyperthyroidism , Purpura , Adult , Antibodies, Antineutrophil Cytoplasmic , Antithyroid Agents/adverse effects , Female , Humans , Hyperthyroidism/chemically induced , Hyperthyroidism/complications , Hyperthyroidism/diagnosis , Propylthiouracil/adverse effectsABSTRACT
UNLABELLED: Standard parenteral nutrition solutions have been developed nationwide in France but little is known about their frequency of use and indications. OBJECTIVES: To evaluate the frequency of the use of standardized parenteral nutrition solutions in neonatal units in France, to determine which solutions are currently available and used, and to determine whether the available parenteral nutrition solutions are satisfactory to the prescriber by evaluating the type and number of additions most frequently prescribed. METHOD: National survey performed in France, using a questionnaire sent to 296 French neonatal departments. RESULTS: Eighty-five percent of level III units and 50% of the level II units responded to the questionnaire. Standardized parenteral nutrition solutions were used in 66% of the responding units and accounted for 45% of the prescriptions of parenteral nutrition in newborns. They were significantly more frequently prescribed by level II than level III units (68% vs. 24%, p<0.0001). Thirteen of the 40 standard solutions declared as solutions for parenteral nutrition did not contain amino acids. The addition of macro- and/or micronutrients was very frequent and often made even if not indicated in the Consumer Medicine Information (CMI). CONCLUSION: There is great heterogeneity in parenteral nutrition practices among French neonatal units. A large number of the standard solutions used are not appropriate for the nutrition of full-term and/or preterm infants. Their use in everyday practice does not cover the nutritional needs of the newborn or induces at-risk practices such as supplementation with macro- and/or micronutrients.