TY - JOUR T1 - Concurrent Takayasu’s Arteritis and Antineutrophil Cytoplasmic Antibody-related Glomerulonephritis Related to Use of Propylthiouracil JF - The Journal of Rheumatology JO - J Rheumatol SP - 1552 LP - 1553 DO - 10.3899/jrheum.081177 VL - 36 IS - 7 AU - JULIE C. BAKER-LePAIN AU - MARY K. FARMER-BOATWRIGHT AU - MARY ANN DOOLEY Y1 - 2009/07/01 UR - http://www.jrheum.org/content/36/7/1552.abstract N2 - To the Editor:Propylthiouracil (PTU) is a thioamide used to treat the hyperthyroid state of Graves’ disease1. Among the side effects of this medication, the induction of antineutrophil cytoplasmic antibodies (ANCA) has gained recent attention1. It has been shown that the antigenic target of cytoplasmic ANCA (c-ANCA) is proteinase 3, whereas that of perinuclear ANCA (p-ANCA) is usually myeloperoxidase, although other intracellular molecules are sometimes targets2. Children are at relatively high risk for developing PTU-related autoimmune disorders because of the long duration of this therapy while awaiting radioablation or surgery1. We describe a rare case of concurrent Takayasu’s arteritis and p-ANCA-associated crescentic glomerulonephritis associated with a 20-year history of PTU use.A 29-year-old African American woman was admitted to the nephrology service at the University of North Carolina, Chapel Hill, with progressive renal failure. She had fever, fatigue, hoarseness, and an unintentional 15-lb (6.8 kg) weight loss beginning after the birth of a healthy male infant 8 months previously, followed by 2–3 days of nausea and vomiting. Serum creatinine was 4.0 mg/dl on presentation. Urinalysis showed 2+ protein, > 150 red blood cells per high power field, and 18 white blood cells per high power field. A 24-h urine specimen showed protein of 4.7 g, with urine protein-to-creatinine ratio of 5.740. Serum protein electrophoresis was negative for monoclonal gammopathy. The patient underwent renal biopsy, and histopathology showed pauciimmune crescentic glomerulonephritis. Noncontrast computed tomography of the neck, done to evaluate hoarseness, showed a vascular mass in the right anterior neck. Magnetic resonance angiogram of the neck and chest showed severe dilatation of the ascending through mid-descending thoracic aorta to a maximum diameter of 6.8 cm (Figure … Address reprint requests to Dr. J.C. Baker-LePain, Division of Rheumatology, Department of Medicine, San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA. ER -