Propylthiouracil 屬thionamide 類的藥品，機轉為抑制甲狀腺素之合成，主要用於甲狀腺機能亢進症之治療。常見的不良反應包括皮疹、蕁麻疹、關節疼痛、噁心、嘔吐、顆粒性白血球缺乏症及急性肝炎等，而相關於抗嗜中性球細胞質抗體陽性之快速進行性腎絲球腎炎，是少見但嚴重的不良反應。本案例為67 歲男性，因甲狀腺機能亢進症服用propylthiouracil 長達8 ~ 9 年，近2 個月因為全身持續虛弱無力且合併腎衰竭而入院治療。初步排除感染性疾病、惡性腫瘤及其他因素後，高度懷疑與propylthiouracil 相關，立即停藥並做腎臟病理切片，結果為新月形腎絲球腎炎，積極給與類固醇與免疫抑制劑治療後情況穩定出院。依據Naranjo scale 評估Propylthiouracil 與不良反應之關聯性為7 分，屬於「極有可能」。希望藉由本案例報告及文獻回顧，能讓更多臨床醫療人員瞭解快速進行性腎絲球腎炎的診斷及治療；一旦發生此不良反應時，能及早停藥並給予積極治療，以降低此不良反應所導致的尿毒症及死亡率。

Propylthiouracil (PTU) is a thionamide drug to treat hyperthyroidism by inhibiting the synthesis of thyroxine. Common adverse effects include skin rash, arthritis, nausea, vomiting, agranulocytosis, and acute hepatitis. Antineutrophil cytoplasmic antibody (ANCA)-positive rapidly progressive glomerulonephritis (RPGN) is a rare and severe adverse effect of PTU.
A 67-year-old man with progressive general malaise and weakness for about 1 month was admitted to our hospital for renal failure. He had hyperthyroidism and had been treated with PTU for about 9 year. After excluding other differential diagnoses such as infections and malignancy, PTU was highly suspected as the culprit for the renal failure. Therefore, PTU was discontinued and he was given corticosteroid pulse therapy and an immunosuppressant. Renal biopsy revealed pauci-immune crescentic glomerulonephritis. By the Naranjo scale the probability of the association of PTU with the adverse event in this case was at a score of 7 (highly likely). This case illustrated the potential side effect of reno-toxicity associated with long-term PTU use. It is important to know the adverse effect of PTU on the kidney and take action earlier in order to avoid irreversible renal outcomes and even mortality.