Antineutrophil cytoplasmic autoantibody-positive crescentic glomerulonephritis associated with thiamazole therapy.

Yuichi Hori, Nephrology Center, Toranomon Hospital, Minato-ku, Tokyo 105 (Japan) Dear Sir, Antineutrophil cytoplasmic autoantibod-ies (ANCA) have been described as serologic markers related with vasculitic disorders [ 1]. Dolman et al. [2] reported 6 patients with ANCA-positive vasculitis associated with propylthiouracil (PTU) therapy, and Vogt et al. [3] added 2 patients with ANCA-positive crescentic glomerulonephritis after the same treatment. Indeed, reports on ANCA-related syndrome associated with PTU treatment have been increasing in Japan also, but there has never been a report on cases of ANCA-related syndrome associated with thiamazole (MMI), another antithyroid drug, therapy. We describe ANCA-positive crescentic glomerulonephritis with pulmonary involvement in association with treatment with MMI. In 1987, a 49-year-old man was diagnosed as having Graves’ disease. He was given MMI 5-10 mg daily for 6 years and had been euthyroid since. In October 1993, when he was found to have slight hypofunction of thyroid, administration of MMI was discontinued. In January 1994, MMI (5 mg/day) was resumed because of relapse of hyperthy-roidism. In order to perform the ‘block and replace therapy’, which is a combination therapy of MMI and thyroxine, the dose of MMI was increased to 30 mg/day in May 1994 and 2 months later, to 45 mg/day. Around that time, fever, cough and proximal myalgia of lower extremities developed. He was admitted to our hospital in August 1994. He had lost 3 kg in 6 months. On physical examination, he had fine crackles in bilateral lower lung fields. The chest radiograph and computed tomography (CT) scan showed interstitial shadows in the lower lobes on both