Može li propiltiouracil izazvati autoimunski posredovanu imunotoksičnost?
Sažetak
Uvod. Propiltiouracil može biti povezan sa blagim neželjenim efektima, ali se u praksi mogu videti i ozbiljne komplikacije, poput agranulocitoze i vaskulitisa. U literaturi je kao mogući mehanizam nastanka agranulocitoze opisana direktna toksičnost i imunski posredovana aktivacija antineutrofilnih i anticitoplazmatskih antitela. Većina vaskulitisa je udružena sa antitelima na mijeloperoksidazu, ali nije poznat tačan mehanizam nastanka vaskulitisa udruženih sa antineutrofilnim citoplazmatskim antitelima kao neželjenim dejstvom terapije propiltiouracilom. Prikaz bolesnika. Prikazana je bolesnica sa Bazedovljevom (Grejsovom) bolesti, stara 61 godinu, koja se javila lekaru zbog povišene telesne temperature i bolova u grlu, dve nedelje nakon započinjanja terapije propiltiouracilom. Verifikovana je agranulocitoza kao i levostrana bazalna pneumonija. Obustavljena je primena propiltiouracila, a započeta terapija antibioticima širokog spectra, uz Lugolov rastvor, metilprednizolon i faktor stimulacije kolonije granulocta. Dalji tok se komplikovao pojavom generalizovane, eritematozno-papulomatozne ospe. Kod bolesnice je postavljena dijagnoza agranulocitoze i vaskulitisa udruženog sa antitelima na mijeloperoksidazu i antineutrofilnim citoplazmatskim antitelima, kao neželjenim dejstvima propiltiouracila. Zaključak. Bolesnici koji imaju Grejvsovu bolest, sa istovremenom agranulocitozom i vaskulitisom udruženim sa antineutrofilnim citoplazmatskim antitelima kao komplikacijom terapije propiltiouracilom, su retki u kliničkoj praksi. Hitan prekid terapije antitiroidnim lekom je od velikog značaja za smanjenje oštećenja ciljnih organa. Sličnost u patogenezi oba stanja mogla bi objasniti istovremenu pojavu ta dva neželjena dejstva, što zahteva dalja istraživanja.
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