CASE REPORT article
Front. Pediatr.
Sec. Pediatric Rheumatology
This article is part of the Research TopicNew Insights in Pediatric Rheumatology: Advances in Diagnosis and TreatmentView all 4 articles
Rapid-Onset Methimazole-Induced Lupus in a Pediatric Patient With Graves' Disease: A Case Report and Review of the Literature
Provisionally accepted
- Al-Quds University, Abu Dis, Palestine
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Graves' disease (GD) is the leading cause of autoimmune hyperthyroidism, yet pediatric cases are uncommon. Methimazole (MMI) remains the first-line therapy; however, drug-induced lupus erythematosus (DILE) secondary to MMI is rare and may be overlooked. We report a 16-year-old girl with newly diagnosed GD who developed inflammatory polyarthritis, a diffuse pruritic maculopapular rash, and alopecia within one week of starting MMI (10 mg/day). Laboratory evaluation showed positive antinuclear antibodies and positive anti-histone antibodies, with reduced complement C3 and low-normal C4; anti–double-stranded DNA and extractable nuclear antigen antibodies were negative, and urinalysis was normal. MMI was discontinued and oral prednisone (20 mg/day) initiated, resulting in marked improvement within one week and complete symptom resolution by day 10–14. This presentation is notable for the unusually rapid onset of MMI-associated DILE in an adolescent and the presence of alopecia, a feature more typical of idiopathic SLE than classic DILE. The case underscores the importance of maintaining a high index of suspicion for DILE shortly after antithyroid drug initiation, carefully differentiating it from idiopathic SLE using serology and clinical course, and promptly withdrawing the offending agent. Early recognition and short courses of corticosteroids can lead to rapid, complete recovery and help avoid unnecessary investigations or prolonged morbidity.
Keywords: Methimazole-induced lupus, Graves' disease, Drug-induced lupus erythematosus, Alopecia, case report
Received: 17 Aug 2025; Accepted: 24 Nov 2025.
Copyright: © 2025 Deeb, Deeb, Badawi, Alfrookh, Douden and Atawnah. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Nouraldeen Deeb
Salahaldeen Deeb
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