摘要1例20岁女性患者因甲状腺功能亢进症(甲亢)口服丙硫氧嘧啶(PTU) 100 mg/d,2年后出现痰中带血伴眼红,诊断为PTU相关性血管炎.停用PTU,予泼尼松20 mg/d口服,症状好转.20 d后,泼尼松减量至5 mg/d,咯血再发,伴左耳廓红肿.实验室检查:游离三碘甲状腺原氨酸5.78 pmol/L,游离甲状腺素2.69 pmol/L,促甲状腺素0.007 mU/L;抗核抗体1:320(+),斑点型;核周型抗中性粒细胞胞质抗体(ANCA)(+),髓过氧化物酶(MPO) 79.3 RU/ml,蛋白酶3(PR3)2.2 RU/ml.胸部CT示双肺多发斑片影.诊断:PTU致ANCA相关性血管炎;甲亢.予甲泼尼龙40 mg/d静脉滴注,甲巯咪唑5 mg/d口服.1周后,患者咯血、耳廓红肿消退,改为口服泼尼松.1年后,患者自行停用泼尼松.5个月后,患者再次出现咯血.实验室检查:核周型ANCA(+),MPO72.0 RU/ml,PR3 2.0 RU/ml.考虑ANCA相关性血管炎复发,停用甲巯咪唑,予甲泼尼龙40 mg/d静脉滴注.1周后患者咯血明显缓解.改为口服泼尼松.5个月后,患者右耳廓出现红色斑丘疹,复查MPO为112.0 RU/ml,』加用甲氨蝶呤(10 mg,1次/周)口服.6个月后,红色斑丘疹消退,MPO降至78.0 RU/ml,停用甲氨蝶呤.

abstractsA 20-year-old female patient received oral propylthiouracil (PTU) 100 mg/d for hyperthyroidism.After 2 years, she noticed blood in phlegm and had red eye.PTU-associated vasculitis was diagnosed.PTU was stopped and oral prednisone 20 mg/d was given.Her symptoms improved.Twenty days later, prednisone dosage was reduced to 5 mg/d, hemoptysis appeared again with swelling in the left ear.Laboratory testing showed the following results: free triiodothyronine 5.78 pmol/L, free thyroxine 2.69 pmol/L, thyroid-stimulating hormone 0.007 mU/L, antinuclear antibody 1 : 320 (+), spotted type,perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) (+), myeloperoxidase(MPO)79.3 RU/ml,proteinase 3 (PR3) 2.2 RU/ml.Chest CT shows multiple patchy opacities in both lungs.PTU induced antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis and hyperthyroidism were diagnosed.Ⅳ infusion of methylprednisolone 40 mg/d and oral methimazole 5 mg/d were given.Hemoptysis and auricle swelling subsided after one week.Methylprednisolone was switched to oral prednisone.One year later,prednisone was stopped without physician's advise.Five months later, recurrence of hemoptysis occurred.Laboratory testing showed p-ANCA (+), MPO 72.0 RU/ml, and PR3 2.0 RU/ml.ANCA-associated vasculitis recurrence was considered.Methimazole was stopped and Ⅳ infusion of methylprednisolone 40 mg/d was given.Hemoptysis was alleviated obviously after one week and oral prednisone was continued.Five months later, red maculopapule appeared on her right auricle.MPO was 112.0 RU/ml.Oral methotrexate 10 mg once weekly was added.Red maculopapule faded and MPO was reduced to 78.0 RU/ml after 6 months.Methotrexate was withdrawn.