Abstract

DRUG-INDUCED ANTI-NEUTROPHIL CYTOPLASMIC ANTIBODIES (ANCA)-ASSOCIATED VASCULITIS: CLINICAL FEATURES, DIAGNOSTIC APPROACHES, AND MANAGEMENT WITH A FOCUS ON PROPYLTHIOURACIL

P. Thanay Kumar Pharm D (Guide), R. Surendra*, S. Hamedunnisa Begam and
V. C. Parvathy

ABSTRACT

Drug-induced anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) presents a challenging diagnostic andtreatment dilemma due to its intricate biology and broad spectrum ofclinical symptoms. This study's primary focus is on drug-inducedAAV's clinical features, diagnostic strategies, and treatment, with aparticular emphasis on propylthiouracil (PTU). AAV can seriouslyharm multiple organs by targeting small to medium-sized bloodarteries. Eosinophilic Granulomatosis with Polyangiitis (EGPA),Microscopic Polyangiitis (MPA), and Granulomatosis with Polyangiitis(GPA) are all included in it. To provide the right care, it is imperativeto distinguish between idiopathic and drug-induced AAV. Although lesscommon, drug-induced AAV poses unique challenges, particularlywhen it originates from PTU, a medication used to treathyperthyroidism. PTU generates AAV, which then triggers theformation of ANCA and vasculitis by mechanisms including themodification of native proteins. Diagnosing medication-induced AAV requires a completehistory, physical examination, ANCA testing, renal function assessments, imaging, andbiopsy. Effective management requires corticosteroids, immunosuppressive drugs, supportivecare, and an abrupt stop to the offending substance. In severe cases, advanced therapy—including plasma exchange—might be required. Relapse is still a possibility, although the prognosis for drug-induced AAV is often positive with prompt intervention and appropriatecare. Further research is essential to elucidate drug-specific mechanisms, supply advanceddiagnostic tools, and explore novel therapeutic options to improve patient outcomes andsafety in the treatment of drug-induced AAV.

Keywords: ANCA-associated vasculitis (AAV), Propylthiouracil (PTU), Granulomatosis with Polyangiitis (GPA), Microscopic Polyangiitis (MPA), Eosinophilic Granulomatosis with Polyangiitis (EGPA), Drug-induced vasculitis.