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February 1983, Vol 137, No. 2 >
Article | February 1983

Vasculitis, Pulmonary Cavitation, and Anemia During Antithyroid Drug Therapy FREE

Fernando G. Cassorla, MD; David N. Finegold, MD; John S. Parks, MD, PhD; Alfred Tenore, MD; Hasina Thawerani, MD; Lester Baker, MD
[+] Author Affiliations

Reprint requests to Developmental Endocrinology Branch, Bldg 10, Room 10B09, National Institutes of Health, Bethesda, MD 20205 (Dr Cassorla).


Am J Dis Child. 1983;137(2):118-122. doi:10.1001/archpedi.1983.02140280016005.
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• Two thyrotoxic girls, aged 12 and 16 years, had a clinical picture consisting of purpuric skin rash, nephritis, pulmonary cavitation, hemoptysis, and profound anemia during antithyroid drug therapy. These major toxic manifestations prompted discontinuation of antithyroid drugs and institution of antibiotic and glucocorticoid therapy before the resolution of the severe illness. The girls eventually required ablative doses of radioactive iodine, and one of them had a thyroidectomy for the treatment of thyrotoxicosis. The skin biopsy specimen in one patient was indicative of mononuclear cell cutaneous vasculitis. After recovery, the patients had no evidence of persistent anemia, nephritis, or pulmonary parenchymal disease.

(Am J Dis Child 1983;137:118-122)

REFERENCES

1 +
Hung W, Wilkins L, Blizzard RM:  Medical therapy of thyrotoxicosis in children . Pediatrics 1962;;30:17-27.
2 +
McKendrick T, Newns GH:  Thyrotoxicosis in children: A follow-up study . Arch Dis Child 1965;;40:71-76.
3 +
Vaidya VA, Bongiovanni AM, Parks JS, et al:  Twenty-two years' experience in the medical management of juvenile thyrotoxicosis . Pediatrics 1974;;54:565-570.
4 +
Barnes HV, Blizzard RM:  Antithyroid drug therapy for toxic diffuse goiter (Graves' disease): Thirty years' experience in children and adolescents . J Pediatr 1977;;91:313-320.
5 +
Collen RJ, Landow EM, Kaplan SA, et al:  Remission rates of children and adolescents with thyrotoxicosis treated with antithyroid drugs . Pediatrics 1980;;65:550-556.
6 +
Maenpaa J, Kuusi A:  Childhood hyperthyroidism: Results of treatment . Acta Pediatr Scand 1980;;69:137-142.
7 +
Amrhein JA, Kenny FM, Ross D:  Granulocytopenia, lupus-like syndrome, and other complications of propylthiouracil therapy . J Pediatr 1970;;76:54-63.
8 +
Hothem AL, Thomas CG, Van Wyk JJ:  Selection of treatment in the management of thyrotoxicosis in childhood and adolescence . Ann Surg 1978;;187:593-598.
9 +
Librik L, Sussman L, Bejar R, et al:  Thyrotoxicosis and collagen-like disease in three sisters of American Indian extraction . J Pediatr 1970;;76:64-68.
10 +
McCormick RV:  Periarteritis occurring during propylthiouracil therapy . JAMA 1950;; 144:1453-1454.
11 +
Vasily DB, Tyler WB:  Propylthiouracil-induced cutaneous vasculitis: Case presentation and review of the literature . JAMA 1980;;243:458-461.
12 +
Buckingham BA, Costin G, Roe TF, et al:  Hyperthyroidism in children: A reevaluation of treatment . Am J Dis Child 1981;;135:112-117.
13 +
Yang LC, Norman ME, Doughty RA:  A micromethod for the analysis of cryoglobulins via laser nephelometry: Evaluation and comparison to C1q binding activity in autoimmune diseases in pediatrics . Pediatr Res 1980;;14:858-862.
14 +
Solomon DH:  Antithyroid drugs , in Werner SC, Ingbar SH (eds): The Thyroid . Hagerstown, Md, Harper & Row Publishers Inc, 1978;, pp 814-821.
15 +
McCarthy JT, Kesten BM:  The problem of allergic cutaneous vasculitis . Ann Allergy 1959;; 17:519-533.
16 +
Horvath F, Teague P, Gaffney EF, et al:  Thyroid antigen associated immune complex glomerulonephritis in Graves' disease . Am J Med 1979;;67:901-904.
17 +
Jordan SC, Buckingham B, Sakai R, et al:  Studies of immune-complex glomerulonephritis mediated by human thyroglobulin . N Engl J Med 1981;;304:1212-1215.
18 +
Cupps TF, Fauci AS: The Vasculitides: Major Problems in Internal Medicine . Philadelphia, WB Saunders Co, 1981;, pp 50-71.
19 +
Andrews BS, Cains G, McIntosh J, et al:  Circulating and tissue immune complexes in cutaneous vasculitis . J Clin Lab Immunol 1979;; 1:311-320.
20 +
Phanuphak P, Kohler PF, Stanford RE, et al:  Value of skin biopsy in vasculitis , abstracted. Clin Res 1978;;26:123.
21 +
Cream JJ:  Cryoglobulins in vasculitis . Clin Exp Immunol 1972;;10:117-126.
22 +
Brouet JC, Clauvel JP, Danon F, et al:  Biologic and clinical significance of cryoglobulins . Am J Med 1974;;57:775-788.
23 +
Hung W, August GP:  A 'collagen like' syndrome associated with antithyroid therapy . J Pediatr 1973;;82:852-854.
24 +
Houston BD, Crouch ME, Brick JE, et al:  Apparent vasculitis associated with propylthiouracil use . Arthritis Rheum 1979;;22:925-928.

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References

1 +
Hung W, Wilkins L, Blizzard RM:  Medical therapy of thyrotoxicosis in children . Pediatrics 1962;;30:17-27.
2 +
McKendrick T, Newns GH:  Thyrotoxicosis in children: A follow-up study . Arch Dis Child 1965;;40:71-76.
3 +
Vaidya VA, Bongiovanni AM, Parks JS, et al:  Twenty-two years' experience in the medical management of juvenile thyrotoxicosis . Pediatrics 1974;;54:565-570.
4 +
Barnes HV, Blizzard RM:  Antithyroid drug therapy for toxic diffuse goiter (Graves' disease): Thirty years' experience in children and adolescents . J Pediatr 1977;;91:313-320.
5 +
Collen RJ, Landow EM, Kaplan SA, et al:  Remission rates of children and adolescents with thyrotoxicosis treated with antithyroid drugs . Pediatrics 1980;;65:550-556.
6 +
Maenpaa J, Kuusi A:  Childhood hyperthyroidism: Results of treatment . Acta Pediatr Scand 1980;;69:137-142.
7 +
Amrhein JA, Kenny FM, Ross D:  Granulocytopenia, lupus-like syndrome, and other complications of propylthiouracil therapy . J Pediatr 1970;;76:54-63.
8 +
Hothem AL, Thomas CG, Van Wyk JJ:  Selection of treatment in the management of thyrotoxicosis in childhood and adolescence . Ann Surg 1978;;187:593-598.
9 +
Librik L, Sussman L, Bejar R, et al:  Thyrotoxicosis and collagen-like disease in three sisters of American Indian extraction . J Pediatr 1970;;76:64-68.
10 +
McCormick RV:  Periarteritis occurring during propylthiouracil therapy . JAMA 1950;; 144:1453-1454.
11 +
Vasily DB, Tyler WB:  Propylthiouracil-induced cutaneous vasculitis: Case presentation and review of the literature . JAMA 1980;;243:458-461.
12 +
Buckingham BA, Costin G, Roe TF, et al:  Hyperthyroidism in children: A reevaluation of treatment . Am J Dis Child 1981;;135:112-117.
13 +
Yang LC, Norman ME, Doughty RA:  A micromethod for the analysis of cryoglobulins via laser nephelometry: Evaluation and comparison to C1q binding activity in autoimmune diseases in pediatrics . Pediatr Res 1980;;14:858-862.
14 +
Solomon DH:  Antithyroid drugs , in Werner SC, Ingbar SH (eds): The Thyroid . Hagerstown, Md, Harper & Row Publishers Inc, 1978;, pp 814-821.
15 +
McCarthy JT, Kesten BM:  The problem of allergic cutaneous vasculitis . Ann Allergy 1959;; 17:519-533.
16 +
Horvath F, Teague P, Gaffney EF, et al:  Thyroid antigen associated immune complex glomerulonephritis in Graves' disease . Am J Med 1979;;67:901-904.
17 +
Jordan SC, Buckingham B, Sakai R, et al:  Studies of immune-complex glomerulonephritis mediated by human thyroglobulin . N Engl J Med 1981;;304:1212-1215.
18 +
Cupps TF, Fauci AS: The Vasculitides: Major Problems in Internal Medicine . Philadelphia, WB Saunders Co, 1981;, pp 50-71.
19 +
Andrews BS, Cains G, McIntosh J, et al:  Circulating and tissue immune complexes in cutaneous vasculitis . J Clin Lab Immunol 1979;; 1:311-320.
20 +
Phanuphak P, Kohler PF, Stanford RE, et al:  Value of skin biopsy in vasculitis , abstracted. Clin Res 1978;;26:123.
21 +
Cream JJ:  Cryoglobulins in vasculitis . Clin Exp Immunol 1972;;10:117-126.
22 +
Brouet JC, Clauvel JP, Danon F, et al:  Biologic and clinical significance of cryoglobulins . Am J Med 1974;;57:775-788.
23 +
Hung W, August GP:  A 'collagen like' syndrome associated with antithyroid therapy . J Pediatr 1973;;82:852-854.
24 +
Houston BD, Crouch ME, Brick JE, et al:  Apparent vasculitis associated with propylthiouracil use . Arthritis Rheum 1979;;22:925-928.

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