July - September 2023, Volume 19, Issue 3

Tomasovic M, Sinik M, Gluvic Z, Zafirovic S, Isenovic E

Case Report of Hand and Foot Skin Changes Resembling PTU-Induced Vasculitis in a Young Male with Diffuse Toxic Goitre

Acta Endo (Buc) 2023, 19 (3): 380-385
doi: 10.4183/aeb.2023.380

Context. Propylthiouracil (PTU) could cause lupus or vasculitis-like hypersensitivities thus interfering with some other concomitant diseases. Objective. Clinicians must be aware of the side effects of medications, particularly after their introduction and long-term use. Some clinical manifestations may be similar to well-known drug side effects or hypersensitivity. Every unusual clinical scenario related to drug use must be evaluated individually and thoroughly. Subjects and Methods. Hands and feet skin changes were observed several days after PTU administration in a male patient with severe diffuse toxic goitre. A complete blood count, biochemistry analyses, thyroid function tests and antibodies, and immunology analyses were performed. Results. As the skin changes were distributed regionally, liver function tests were normal, and there were no signs of clinical deterioration, it was decided to continue PTU treatment and monitor the patient. The initial maculopapular rash quickly turned vesicular, then scaly. After two weeks, the skin changes were wholly restored, with no scarring. Hand, Foot, and Mouth disease (HFMD) was diagnosed after a thorough epidemiological survey and clinical workout. Conclusions. Our case study demonstrates that skin changes associated with HFMD may resemble those associated with PTU-induced vasculitis.

Keywords: Propylthiouracil, autoimmunity, Hand, Foot and Mouth Disease.

Correspondence: Sonja S. Zafirovic, Ph.D., Assist. Res. Prof., University of Belgrade, VINCA Institute of Nuclear Sciences - National Institute of the Republic of Serbia, Dept. of Radiobiology and Molecular Genetics, P.O.Box 522, 11000, Belgrade, Serbia, E-mail: sonjazafirovic@hotmail.com