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We compared data from idiopathic and antithyroid drug (ATD)-induced antineutrophil cytoplasmic antibody (ANCA)-positive patients. From 1993 to 2003, 2474 patients were tested for ANCA in the Laboratory for Allergy and Clinical Immunology in Belgrade. Out of 2474 patients, 72 (2.9%) were anti-proteinase 3 (PR3)- or anti-myeloperoxidase (MPO)-positive and their clinical and serological data were analyzed. The first group consisted of ANCA-associated idiopathic systemic vasculitis (ISV) diagnosed in 56\/72 patients: 29 Wegener's granulomatosis (WG), 23 microscopic polyangiitis (MPA) and four Churg-Strauss syndrome. The second group consisted of 16\/72 patients who became ANCA-positive during ATD therapy (12 receiving propylthiouracil and four receiving methimazole). We determined ANCA and antinuclear (ANA) antibodies by indirect immunofluorescence; PR3-ANCA, MPO-ANCA, anticardiolipin (aCL) and antihistone antibodies (AHA) by ELISA; and cryoglobulins by precipitation. Complement components C3 and C4, alpha-1 antitrypsin (\u03b11 AT) and C reactive protein (CR-P) were measured by nephelometry. Renal lesions were present in 3\/16 (18.8%) ATD-treated patients and in 42\/56 (75%) ISV patients (<jats:italic>p<\/jats:italic> &lt;0.001). Skin lesions occurred in 10\/16 (62.5%) ATD-treated patients and 14\/56 (25%) ISV patients (<jats:italic>p<\/jats:italic> &lt;0.01). ATD-treated patients more frequently had MPO-ANCA, ANA, AHA, aCL, cryoglobulins and low C4 (<jats:italic>p<\/jats:italic> &lt;0.01). ISV patients more frequently had low \u03b11 AT (<jats:italic>p<\/jats:italic> = 0.059) and high CR-P (<jats:italic>p<\/jats:italic> &lt;0.001). Of 16 ATD-treated patients, four had drug-induced ANCA vasculitis (three MPA and one WG), while 12 had lupus-like disease (LLD). Of 56 ISV patients, 13 died and eight developed terminal renal failure (TRF). There was no lethality in the ATD-treated group, but 1\/16 with methimazole-induced MPA developed pulmonary-renal syndrome with progression to TRF. ANCA-positive ISV had a more severe course in comparison with ATD-induced ANCA-positive diseases. Clinically and serologically ANCA-positive ATD-treated patients can be divided into two groups: the first consisting of patients with drug-induced WG or MPA which resemble ISV and the second consisting of patients with LLD. Different serological profiles could help in the differential diagnosis and adequate therapeutic approach to ANCA-positive ATD-treated patients with symptoms of systemic disease.<\/jats:p>","DOI":"10.1186\/ar1789","type":"journal-article","created":{"date-parts":[[2005,7,13]],"date-time":"2005-07-13T21:23:07Z","timestamp":1121289787000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":101,"title":["Antineutrophil cytoplasmic antibody (ANCA)-associated autoimmune diseases induced by antithyroid drugs: comparison with idiopathic ANCA vasculitides"],"prefix":"10.1186","volume":"7","author":[{"given":"Branka","family":"Bonaci-Nikolic","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milos M","family":"Nikolic","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sladjana","family":"Andrejevic","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Svetlana","family":"Zoric","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mirjana","family":"Bukilica","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2005,7,13]]},"reference":[{"key":"1668_CR1","doi-asserted-by":"publisher","first-page":"1512","DOI":"10.1056\/NEJM199711203372106","volume":"337","author":"JC Jennette","year":"1997","unstructured":"Jennette JC, Falk RJ: Small-vessels vasculitis. 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