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Disseminated intravascular coagulation and vasculitis during propylthiouracil therapy

The use of antithyroid drugs in the early 1940s revolutionised the management of hyperthyroidism. Since their introduction, a variety of adverse reactions, including haematological, dermatological, and rheumatological effects, have been associated with these drugs. The incidence of these side-effects is similar to many other commonly used drugs, ie, 1–5%.1 The most common side-effects include skin rash, fever, arthralgias/arthritis and neutropenia while lupus-like reaction, vasculitis, hepatitis, agranulocytosis and thrombocytopenia are uncommon.2 Disseminated intravascular coagulation (DIC) is a rare adverse effect of propylthiouracil therapy.3 Herein we report a case of DIC and vasculitis following a short course of propylthiouracil therapy.

A 42-year-old African-American woman with Grave's disease, diagnosed 20 years earlier, had received propylthiouracil (100 mg tid) for the past 2 weeks because of recent exacerbation of symptoms. She was admitted to the hospital because of sudden onset of palpable purpuric rash, which started on the face and later spread to her trunk and extremities.

Laboratory test results on admission disclosed the following data: haemoglobin 12.2 g/dl, haematocrit 37.8, white blood cells 15.5 × …