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Methimazole-induced lupus erythematosus: a case report
Li-Chieh Wang1, Wen-Yu Tsai, Yao-Hsu Yang
1Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan, ROC.
Summary
Methimazole, a medication for hyperthyroidism, can rarely cause autoimmune conditions like lupus nephritis. Prompt diagnosis and treatment with immunosuppressants led to full recovery in a 15-year-old patient.
Area of Science:
- Nephrology
- Rheumatology
- Endocrinology
Background:
- Methimazole is a common treatment for hyperthyroidism.
- Drug-induced autoimmune diseases are a recognized but rare complication of methimazole therapy.
Observation:
- A 15-year-old female presented with edema, leukopenia, anemia, proteinuria, and granular casts.
- Laboratory findings included positive antinuclear antibodies, anti-dsDNA antibodies, and myeloperoxidase antineutrophil cytoplasmic antibodies.
- Renal biopsy confirmed focal segmental glomerulosclerosis.
Findings:
- Methimazole was discontinued, and the patient was treated with prednisolone and Plaquenil (hydroxychloroquine).
- Symptoms and laboratory abnormalities resolved within 40 days.
- The patient remained symptom-free for 21 months on hydroxychloroquine and levothyroxine.
Implications:
- This case highlights the importance of considering drug-induced lupus nephritis in patients on methimazole presenting with nephrotic syndrome and autoimmune markers.
- Early recognition and management with immunosuppressive therapy are crucial for favorable outcomes.
- Long-term monitoring may be necessary to prevent relapse.