We present a case study of a 40-year-old female patient with Graves' disease who had been diagnosed 14 years ago and treated with propylthiouracil for 6 years The patient had no symptoms till the last three months. The patient was admitted to our hospital with the clinical findings of thyrotoxicosis and treated with propylthiouracil (PTU, 400 mg/day). Two weeks later, bullous hemorrhagic and necrotic ulcers on extremities and hematuria appeared. The clinical diagnosis of leucocytoclastic vasculitis was confirmed on skin biopsy. Examination of a renal biopsy specimen showed glomerulonephitis. Serologic examination revealed positive antineutrophil cytoplasmic antibody (ANCA). After the discontinuation of PTU and administration of prednisolone the ulcers disappeared and renal functions recovered gradually. Thyroid function was kept within the normal range using radioiodine.
Keywords: Hyperthyroidism, propylthiouracil, vasculitis, antineutrophil