Case Report Shows Carbimazole's ‘Triple-Hit’
Diffuse alveolar hemorrhage with coexistent antiphospholipid syndrome complicated anticoagulation therapy and created competing bleeding and thrombosis risks.
By
Andrea Surnit
April 1, 2026
Clinical Scorecard: Case Report Shows Carbimazole's ‘Triple-Hit’
At a Glance
Category Detail
Condition Microscopic polyangiitis with diffuse alveolar hemorrhage and antiphospholipid syndrome Key Mechanisms Vasculitis, thrombosis, immune-complex deposition Target Population Patients with hyperthyroidism on long-term carbimazole therapy Care Setting General medicine
Key Highlights
Patient developed vasculitis and APS after 15 years of carbimazole treatment Rapid stabilization achieved through plasmapheresis Disease activity measured with Birmingham Vasculitis Activity Score (BVAS) of 14 Near-complete resolution of pulmonary hemorrhage post-treatment Carbimazole reintroduced without recurrence of vasculitis Guideline-Based Recommendations
Diagnosis
Confirm diagnosis with imaging and laboratory evaluation for vasculitis and APS Management
Discontinue carbimazole; initiate pulse methylprednisolone and intravenous cyclophosphamide Perform plasmapheresis for rapid stabilization Monitoring & Follow-up
Monitor disease activity with BVAS and renal function Risks
Consider competing risks of hemorrhage and thrombosis in treatment decisions Patient & Prescribing Data
29-year-old female with hyperthyroidism
Aspirin initiated for APS; systemic anticoagulation deferred due to bleeding risk
Clinical Best Practices
Rapid initiation of plasmapheresis is critical for stabilization Careful monitoring of renal function and disease activity is essential Evaluate risks of bleeding and thrombosis when managing APS Related Resources & Content
