{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T19:25:15Z","timestamp":1780514715631,"version":"3.54.1"},"reference-count":17,"publisher":"SMC Media","issue":"5","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Introduction:\u00a0Propylthiouracil (PTU) is typically used as first line therapy for hyperthyroidism but is associated with a spectrum of adverse effects including vasculitis, that may lead to acute renal failure and exceptionally to pancreatitis, represents the most severe. Case description:\u00a0Here we present the case of a 43-year-old woman with a history of Graves\u2019 disease until recently on PTU therapy, who presented with fever and myalgia complicated by cold agglutinin disease, acute renal failure and pancreatitis. Subsequent laboratory studies and thorough physical examination excluding other causes revealed the presence of antibodies against leukocyte proteinase 3. Prompt initiation of immunosuppressive therapy and plasmapheresis led to immediate improvement of the patient\u2019s clinical condition and laboratory tests. Conclusion:\u00a0Clinicians should maintain a high index of suspicion for autoimmune phenomena in patients receiving PTU even after cessation of the medication. Early recognition, immediate discontinuation of the drug, and timely initiation of immunosuppressive therapy are essential to prevent irreversible organ damage.<\/jats:p>","DOI":"10.12890\/2026_006500","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T09:33:42Z","timestamp":1776850422000},"source":"Crossref","is-referenced-by-count":1,"title":["From thyroid therapy to systemic crisis: PTU-induced c-ANCA vasculitis accompanied by cold-agglutinin disease and organ failure"],"prefix":"10.12890","volume":"13","author":[{"given":"Pelagia","family":"Kefala-Karli","sequence":"first","affiliation":[{"name":"Paphos General Hospital, State Health Organization Services, Paphos, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodosia","family":"Christou","sequence":"first","affiliation":[{"name":"Paphos General Hospital, State Health Organization Services, Paphos, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisavet","family":"Georgiou","sequence":"first","affiliation":[{"name":"Paphos General Hospital, State Health Organization Services, Paphos, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Despina","family":"Pavlou","sequence":"first","affiliation":[{"name":"Paphos General Hospital, State Health Organization Services, Paphos, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Kapouralos","sequence":"first","affiliation":[{"name":"Paphos General Hospital, State Health Organization Services, Paphos, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyriakos","family":"Panagi","sequence":"first","affiliation":[{"name":"Paphos General Hospital, State Health Organization Services, Paphos, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantina","family":"Chalmoukou","sequence":"first","affiliation":[{"name":"Paphos General Hospital, State Health Organization Services, Paphos, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10397","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"10.12890\/2026_006500_ref1","doi-asserted-by":"crossref","unstructured":"Azizi F. The safety and efficacy of antithyroid drugs. Expert Opin Drug Saf 2006;5:107-116. doi: 10.1517\/14740338.5.1.107","DOI":"10.1517\/14740338.5.1.107"},{"key":"10.12890\/2026_006500_ref2","doi-asserted-by":"crossref","unstructured":"Kitching AR, Anders HJ, Basu N, Brouwer E, Gordon J, Jayne DR, et al. ANCA-associated vasculitis. Nat Rev Dis Primers 2020;6:71. doi: 10.1038\/s41572-020-0204-y","DOI":"10.1038\/s41572-020-0204-y"},{"key":"10.12890\/2026_006500_ref3","doi-asserted-by":"crossref","unstructured":"Almeida MS, Ramalho C, Gomes F, Ginga MDR, Vilchez J. Propylthiouracil-Induced Skin Vasculitis. Cureus 2022;14:e27073. doi: 10.7759\/cureus.27073","DOI":"10.7759\/cureus.27073"},{"key":"10.12890\/2026_006500_ref4","doi-asserted-by":"crossref","unstructured":"Gabbard AP, Booth GS. Cold Agglutinin Disease. Clin Hematol Int 2020;2:95-100. doi: 10.2991\/chi.k.200706.001","DOI":"10.2991\/chi.k.200706.001"},{"key":"10.12890\/2026_006500_ref5","doi-asserted-by":"crossref","unstructured":"Weng CH, Liu ZC. Drug-induced anti-neutrophil cytoplasmic antibody-associated vasculitis. Chin Med J (Engl) 2019;132:2848-2855. doi: 10.1097\/CM9.0000000000000539","DOI":"10.1097\/CM9.0000000000000539"},{"key":"10.12890\/2026_006500_ref6","doi-asserted-by":"crossref","unstructured":"Yamauchi K, Sata M, Machiya J, Osaka D, Wada T, Abe S, et al. Antineutrophil cytoplasmic antibody positive alveolar haemorrhage during propylthiouracil therapy for hyperthyroidism. Respirology 2003;8:532-535. doi: 10.1046\/j.1440-1843.2003.00499.x","DOI":"10.1046\/j.1440-1843.2003.00499.x"},{"key":"10.12890\/2026_006500_ref7","doi-asserted-by":"crossref","unstructured":"Khalaf R, Mhesin D, Abu Salim H, Taha S, Abed W. Propylthiouracil-induced vasculitis with alveolar hemorrhage after 31 years of treatment: a case report. 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