Drug-induced vasculitis: a clinical and pathological review

Rapid deterioration of the patient’s condition afteradmission led to the diagnosis of myxedema coma. LT3 administration should be considered as an alternative treatment for myxedema coma patients requiring concomitant glucocorticoid administration. Beyond this, we cannot ignore the established phenomenon of overlapping syndromes of systemic and organ-specific autoimmune diseases. Among others, Biro et al., in a population of 1517 patients with various autoimmune diseases, found that the prevalence of Hashimoto’s thyroiditis or Grave’s disease was 8.2% 6.

• Categorical data were compared using the chi-square test or Fisher’s exact test.
• The thyroid dysfunction group consisted of one hundred and fifty (86.21%) individuals.
• This report describes a patient with UV triggered by thyroid replacement, necessitated by Hashimoto’s thyroiditis, which can itself cause UV.
• (E) Thyroid echo showed diffuse atrophy of the thyroid gland, irregular surface, and rough and low echo levels inside the thyroid gland.

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• Kaplan–Meier analysis was used to analyze survival rates of the normal thyroid function group and thyroid dysfunction group and to create graphs of the observed survival curves, while the log-rank test was used to compare curves from different groups.
• After careful and precise consideration, we screened out and excluded two patients with primary hyperthyroidism and 460 patients with a lack of thyroid-related laboratory tests or medical record integrity, and 174 AAV patients were finally included in the study.
• There were no significant differences in thyroid hormone levels among groups of patients with different ANCA positivity status.
• Rapid deterioration of the patient’s condition after admission led to the diagnosis of myxedema coma.

Direct immunofluorescence (DIF) antibody localization demonstrated negative immunoreactivity for immunoglobulins IgG, IgA, IgM, and complement C3 on sections of frozen skin. UV was suspected, and the diagnosis was confirmed when treatment with 0.6 mg twice daily dosing of colchicine resulted in a good clinical response and subsequent remission of his rash. We described the first case of myxedema coma triggered by IgA vasculitis.

3. Relationship between Thyroid Hormone and Clinical Parameters in AAV Patients with Renal Injury

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She was diagnosed with coexisting immunoglobulin A (IgA) vasculitis and severe IgA vasculitis with nephritis and was consequently treated with intravenous methylprednisolone (125 mg/day). However, she rapidly developed multiple organ failure due to the exacerbation of severe hypothyroidism, i.e., myxedema. Her condition improved significantly following oral administration of prednisolone along with thyroxine. There was a delayed increase in the serum free triiodothyronine level, while the serum free thyroxine level was quickly restored to normal. Rapid deterioration of the patient’s condition after admission led us to diagnose her as having myxedema coma triggered by IgA vasculitis.

The rash consisted of fixed, non-migratory clusters of wheals and pink papules with hyperpigmented macules along the lower back and lower extremities (Figure 1A). Symptom onset typically occurred one month after starting any thyroid replacement medication but would resolve within two months of medication cessation and the addition of systemic corticosteroids. Kidney survival curve of AAV patients with renal injury in different groups. HI, KF, KA, SH, AN, TS, KM, MK, SY, SI, NH, SH, TA, and MN interpreted the data and provided input in the preparation of the manuscript. Figure1 Images of the lower legs, chest X-ray, chest computed tomography, electrocardiogram, and echocardiogram. (C) No abnormalities were found on the electrocardiogram at the time of admission.

4, 5 However, the causal relationship between Henoch–Schönlein purpura (IgA vasculitis) and Grave’s disease or antithyroid drugs has been remained unclear yet 6. The studies involving human participants were reviewed and approved by Shimada Hospital. The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article. Myxedema coma is an endocrine emergency and fatal disease that is rarely encountered (1). Annually, 1.08 cases per million people in Japan and 0.22 cases per million people in Spain develop myxedema coma (2, 3).

Patients were followed up from the index date until their date of death or March 2022, whichever came first. Information regarding disease progression to the stage of maintenance dialysis or death was collected through telephone inquiries. The authors would like to thank all medical staffs who worked with us at Shimada Hospital for medical supporting and Enago () for the English language review. The original contributions presented in the study are included in the article/Supplementary Material. This section collects any data citations, data availability statements, or supplementary materials included in this article. Written informed consent was obtained from the patient(s) to publish this paper.

A Kolmogorov–Smirnov test and P-P diagram were used for the normality test of the included data. Quantitative parameters were assessed with the t-test between groups for normally distributed data, and non-normally distributed data were assessed with the Mann–Whitney U test. Categorical data were compared using the chi-square test or Fisher’s exact test.

Thyroid Disease in Patients with ANCA-Associated Vasculitis

Urticarial vasculitis (UV) is identified as a clinicopathologic entity that involves clinical features of urticaria and histopathologic findings compatible with a cutaneous leukocytoclastic vasculitis of small vessels with fibrinoid deposits. UV represents a spectrum of diseases that differ in severity, ranging from an urticaria with minimal vasculitis to a systemic disease that can lead to serious organ-specific complications. Certainly, urticarial vasculitis is an underdiagnosed disease, to the extent that its incidence may vary from 3 to 20% 1. This is due to the lack of a consensus in medical literature upon a disease that manifests diversely, with a definite diagnosis that relies on a high-tech procedure such as biopsy.

1. Patients

Disruption of the compensatory mechanism for severe and long-term hypothyroidism by various causes leads to critical conditions, including hypothermia, respiratory failure, circulatory failure, and central nervous system dysfunction. Infectious diseases, stroke, myocardial infarction, sedative drugs, and cold exposure are considered the main triggers for myxedema coma. synthroid scale A 59-year-old Japanese woman presented with bilateral painful purpura on her lower legs.