D-Penicillamine-induced ANCA-associated crescentic glomerulonephritis in Wilson disease.

Author(s): Bienaime F, Clerbaux G, Plaisier E, Mougenot B, Ronco P, Rougier JP

Affiliation(s): Department of Nephrology and Dialysis, Tenon Hospital, APHP, Paris, France.

Publication date & source: 2007-11, Am J Kidney Dis., 50(5):821-5.

Publication type: Case Reports; Research Support, Non-U.S. Gov't

Several drugs, including hydralazine and propylthiouracil, can induce antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. d-Penicillamine was implicated in a few patients with rheumatoid arthritis or systemic sclerosis, but in patients with both diseases, ANCA-associated vasculitides were described in the absence of the drug. Therefore, the role of d-penicillamine treatment could not be established. We report the first case of antimyeloperoxidase antibody-associated vasculitis in a patient treated with d-penicillamine for Wilson disease. Because Wilson disease was never associated with ANCA-related nephritis, this case strongly supports that d-penicillamine can induce ANCA-vasculitis. The presentation and rapidly progressive and potentially severe outcome of this complication dramatically contrast with those of membranous and minimal change glomerulopathy, also induced by the sulfhydryl compound.