Propylthiouracil(PTU) is a commonly used antithyroid drug in the management of hyperthyroidism. However, it is associated with a variety of side effects. Antineutrophil cytoplasmic antibody( ANCA)-positive vasculitis is an extremely rare side effect of PTU. We report a case of a patient with diffuse pulmonary hemorrhage while being treated with PTU. A 28-year-old woman was admitted due to fever and abdominal pain. She was diagnosed as Graves' disease 4 years before the admission, and was taking PTU intermittently. Thyroid storm was suspected and we treated her with PTU, hydrocortisone, lugol solution and propranolol. However, coughing was aggravated, with chest X-ray and computed tomography revealing diffuse alveolar hemorrhage. Perinuclear-ANCA was positive. After discontinuation of PTU, all symptoms resolved. In conclusion, ANCA-positive diffuse alveolar hemorrhage is a rare but a potential side-effect of PTU. Therefore, early awareness of this complication is important.

Cryptococcal infections occur frequently in patients with cell-mediated immune deficiency, such as acquired immune deficiency syndrome, organ transplants, hematologic malignancy patients and immunocompromised patients who receiving cancer chemotherapy or corticosteroid therapy. In these conditions, cryptococcosis can cause serious infections requiring systemic antifungal therapy such as meningoencephalitis and sepsis. However, pulmonary cryptococcosis in immunocompetent hosts may have self-limited course and improve without treatment. We experienced various pulmonary manifestations of pulmonary cryptococcosis in five immunocompetent patients. We diagnosed three cases of isolated pulmonary cryptococcosis and two cases of disseminated cryptococcosis involving lungs. All cases were treated with intravenous injection of amphotericin B during hostpital care, and maintained with oral fluconazole after discharge. During the follow-up, clinical symptoms and radiologic features were markedly improved.

Citations

Citations to this article as recorded by  

• Cryptococcosis with Mediastinal Lymph Node and Lung Involvement in an Immunocompetent Adolescent: A Case Report
  Jiyeon Lee, Chang-Min Cho, Hyun-Hae Cho, Heae Surng Park, Kyung-Hyo Kim
  Pediatric Infection & Vaccine.2021; 28(2): 124.     CrossRef