Antineutrophil cytoplasmic antibodies ANCA

Antithyroid drugs, especially propylthiouracil, can be associated with the development of antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis, often manifesting as renal disease. Atypical presentations, with pulmonary capillaritis (58) and lupus-like syndrome (59), have been described in individual cases. Furthermore, two cases of vasculitis have been associated with carbimazole, one presenting with eosinophilic granulomatous vasculitis localized to the stomach (60) and another with p-ANCA positive vasculitis causing simultaneous acute renal insufficiency and massive pulmonary hemorrhage (61). 

Antineutrophil cytoplasmic antibody (ANCA)-positive cutaneous leucocytoclastic vasculitis associated with antithyroid therapy in Graves disease. Australas J Dermatol 1998 39(2) 96-9. 

Harper L, Chin L, Daykin J, Allahabadia A, Heward J, Gough SC, Savage CO, Franklyn JA. Propylthiouracil and carbimazole associated-antineutrophil cytoplasmic antibodies (ANCA) in patients with Graves disease. Clin Endocrinol (Oxf) 2004 60(6) 671-5. 

Antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis is a well-described complication, particularly with propylthiouracil and to a lesser extent with carbimazole, and has been most often described in patients with Graves disease. The possible drug-induced causes of ANCA-positive vasculitis with high titers of antimyeloperoxidase antibodies in 30 new patients have been reviewed (47). The findings illustrated that this type of vasculitis is a predominantly drug-induced disorder. Only 12 of the 30 cases were not related to a drug. The most frequently implicated drug was hydralazine (n = 10) the remainder involved propylthiouracil n — 3), penicillamine (n = 2), allopurinol n = 2), and sulfasalazine (n = 1). 

Antineutrophil cytoplasmic antibodies (ANCA) are a class of autoantibodies with varied specificities against particular proteins in the cytoplasmic granules of neutrophils and the lysosomes of monocytes. Indirect immunofluorescence microscopy and enzyme immunoassay have defined two types of ANCA patterns one causing cytoplasmic staining (C-ANCA) the other perinuclear staining (P-ANCA) [346]. Greater than 95% of C-ANCA antibiodies are anti-proteinase 3 antibodies (PR3-ANCA) and greater than 95% of P-ANCA antibiodies are anti-myeloperoxidase antibodies (MPO-ANCA) [347]. 

Gao Y, Chen M, Ye El, Guo XEI, Zhao MEI, Wang EIY he target antigens of antineutrophil cytoplasmic antibodies (ANCA) induced by propylthiouracil. Int Immunopharmacol 2007 7 55-60. 

Bonaci-Nikolic B, Nikolic MM, Andrejevic S, Zoric S, Bukilica M Antineutrophil cytoplasmic antibody (ANCA)-associated autoimmune diseases induced by antithyroid drugs comparison with idiopathic ANCA vasculitides. Arthritis Res her 2005 7 R1072-81. 

Numerous drugs have been associated with the development of vasculitis (ten Holder et al. 2002 Cuellar 2002). For example propylthiouracil is associated with cutaneous, renal, and pulmonary vascultis aUopurinol is associated with cutaneous, renal, and hepatic vasculitis hydralazine is associated with cutaneous, renal, and pulmonary vascultis and isotretinoin is associated with cutaneous, renal, pulmonary, and gastrointestinal vascultis (Cuellar 2002 ten Holder et al. 2002). Systemic polyarteritis nodosa, a vasculitis with involvement of small- and mediumsized renal arteries, has been described following minocycline use (Cuellar 2002). Patients may present with hematuria, proteinuria, reduced renal function, and hypertension. Hydralazine, propylthiouracil, aUopurinol, and peniciUamine have been implicated in the development of antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis (Choi et al. 2000). Patients exposed to these drugs... 

Darne S, Natarajan S, Blasdale C. Do antineutrophil cytoplasmic antibodies (ANCA) play a key role in neutrophilic dermatoses A case of propylthiouradl-induced neutrophilic dermatosis with positive perinuclear ANCA. Clin Exp Dermatol 2010 35(4) 406-8. 

Four cases of new or relapsing vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA) have been described after influenza immunization [33. Several trials in patients with pre-existing autoimmune diseases failed to show an... 

TPMT genotype polymorphisms (TPMT 2, 3A, 3B, and 3C) have been studied in 108 patients with vascuhtis associated with positive antineutrophil cytoplasmic antibodies (ANCA), who were given azathioprine and followed for 47 months [144. Adverse reactions (leukopenia, anemia, thrombocytopenia, gastrointestinal adverse reactions including hepatitis, and hypersensitivity reactions) did not differ between patients who were heterozygous and those who were homozygous or between the ter-tiles of patients who were homozygous. 

Rihova Z, Honsova E, Zavada J, et al. Two famihal cases of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Rheumatology (Oxford) 2006 45 356 57. 

Yang G, Tang Z, Chen Y, et al. Antineutrophil cytoplasmic antibodies (ANCA) in Chinese patients with anti-GBM crescentic glomerulonephritis. Chn Nephrol 2005 ... 

According to the Chapel Hill Consensus Conference on the nomenclature of systemic vasculitis (84), CSS belongs to the group of antineutrophil cytoplasmic antibodies (ANCA)-associated smaU-vessel vasculitis and is defined as an eosinophil-rich and granulomatous inflammation involving the respiratory tract, with necrotizing vasculitis affecting small- to medium-sized vessels, and associated with asthma and eosinophiha. 

The only autoantibodies found to be related to Churg and Strauss syndrome are the antineutrophil cytoplasmic antibodies (ANCA), especially the perinuclear ANCA, also referred to as p-ANCA they are directed against myeloperoxidase. High litres of those autoantibodies could be detected in one-half of patients with Churg and Strauss syndrome (Garini G). 

---