{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T10:55:26Z","timestamp":1774608926298,"version":"3.50.1"},"reference-count":17,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2011,1,1]]},"abstract":"<jats:p>Propylthiouracil, a drug commonly used to treat hyperthyroidism, is known to cause antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis as a rare complication. The wide clinical spectrum of propylthiouracil-induced vasculitis ranges from mild forms with rash and\/or arthralgia to severe forms with renal or pulmonary involvement, which can be critical and life-threatening if left unrecognized and untreated. Given its rarity and exceedingly variable clinical presentations, diagnosis may be challenging, and delayed diagnosis is not uncommon without a high index of suspicion, as illustrated by this report of a 17-year-old girl with Graves' disease who developed occult pulmonary hemorrhage as an overlooked rare presentation of ANCA-associated vasculitis after administration of propylthiouracil. Associated clinical features included fever, fatigue, palpable purpura, polyarthritis, and nephritis. Positive findings on chest radiography prompted the bronchoalveolar lavage procedure, which led to the identification of pulmonary hemorrhage. Skin biopsy showed leukocytoclastic vasculitis. Serologic test results were positive for perinuclear ANCA, cytoplasmic ANCA, myeloperoxidase-ANCA, proteinase 3-ANCA, and cryoglobulins but negative for antinuclear antibody, anti\u2013double-stranded DNA, rheumatoid factor, and anti\u2013hepatitis C virus antibody. The symptoms resolved after discontinuation of propylthiouracil and a few months of corticosteroids and azathioprine. This report highlights the necessity for physicians to keep alert for the protean manifestations of propylthiouracil-induced vasculitis.<\/jats:p>","DOI":"10.1542\/peds.2010-0138","type":"journal-article","created":{"date-parts":[[2010,12,7]],"date-time":"2010-12-07T05:31:20Z","timestamp":1291699880000},"page":"e245-e249","source":"Crossref","is-referenced-by-count":12,"title":["Occult Pulmonary Hemorrhage as a Rare Presentation of Propylthiouracil-Induced Vasculitis"],"prefix":"10.1542","volume":"127","author":[{"given":"Yu-Ling","family":"Tu","sequence":"first","affiliation":[{"name":"Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan;"},{"name":"Department of Pediatrics, Chang Gung University College of Medicine, Taoyuan, Taiwan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi-Chan","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Chang Gung University College of Medicine, Taoyuan, Taiwan; and"},{"name":"Department of Pediatrics, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing-Long","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan;"},{"name":"Department of Pediatrics, Chang Gung University College of Medicine, Taoyuan, Taiwan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsung-Chieh","family":"Yao","sequence":"additional","affiliation":[{"name":"Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan;"},{"name":"Department of Pediatrics, Chang Gung University College of Medicine, Taoyuan, Taiwan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2011,1,1]]},"reference":[{"issue":"5","key":"2021120900232380200_B1","doi-asserted-by":"crossref","first-page":"1595","DOI":"10.1378\/chest.102.5.1595","article-title":"Propylthiouracil-induced hypersensitivity vasculitis presenting as respiratory failure","volume":"102","author":"Stankus","year":"1992","journal-title":"Chest"},{"issue":"8872","key":"2021120900232380200_B2","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1016\/0140-6736(93)91761-A","article-title":"Vasculitis and antineutrophil cytoplasmic autoantibodies associated with propylthiouracil therapy","volume":"342","author":"Dolman","year":"1993","journal-title":"Lancet"},{"issue":"2","key":"2021120900232380200_B3","doi-asserted-by":"crossref","first-page":"295","DOI":"10.2214\/ajr.164.2.7839958","article-title":"Diffuse pulmonary hemorrhage: clinical, pathologic, and imaging features","volume":"164","author":"Primack","year":"1995","journal-title":"AJR Am J Roentgenol"},{"issue":"6","key":"2021120900232380200_B4","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1136\/adc.86.6.436","article-title":"Pitfalls in the diagnosis of idiopathic pulmonary haemosiderosis","volume":"86","author":"Yao","year":"2002","journal-title":"Arch Dis Child"},{"issue":"8","key":"2021120900232380200_B5","doi-asserted-by":"crossref","first-page":"2806","DOI":"10.1210\/jc.2008-2700","article-title":"Clinical characteristics of myeloperoxidase antineutrophil cytoplasmic antibody-associated vasculitis caused by antithyroid drugs","volume":"94","author":"Noh","year":"2009","journal-title":"J Clin Endocrinol Metab"},{"issue":"1","key":"2021120900232380200_B6","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.semarthrit.2006.03.003","article-title":"Prophythiouracil-induced autoimmune syndromes: two distinct clinical presentations with different course and management","volume":"36","author":"Aloush","year":"2006","journal-title":"Semin Arthritis Rheum"},{"issue":"1","key":"2021120900232380200_B7","first-page":"48","article-title":"Antineutrophil cytoplasmic autoantibody-positive crescentic glomerulonephritis and pulmonary hemorrhage associated with propylthiouracil: a case report and review of the literature","volume":"20","author":"Hsu","year":"2006","journal-title":"Acta Nephrol"},{"issue":"10","key":"2021120900232380200_B8","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1001\/jama.1995.03520340064038","article-title":"Treatment guidelines for patients with hyperthyroidism and hypothyroidism. 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