Background Vasculitides are generally syndromes of unknown etiology. Although drugs are possible precipitating factors, there are few published series on clinical characterization, and the type of drugs involved.
Objectives Our aim was to study a wide series of unselected drug-induced cutaneous vasculitis.
Methods Retrospective study of patients diagnosed consecutively in the same Universitary hospital as having cutaneous vasculitis due to previous drug intake. Intake of this drug must be new in polymedicated patients and occur in the week before the onset of the vasculitis.
Results According to the above criteria, we found 232 patients (129 men/103 women, mean age 35.9±1.8 years) with cutaneous vasculitis secondary to a new drug in the previous week.
The drugs most frequently involved were: ß-lactam antibiotics [penicillin (80 cases, 34.5%), cephalosporins (12 cases, 5.2%)], quinolones (11 cases, 4.7%), anti-inflammatory [diclofenac (4 cases, 1.7%), ibuprofen (3 cases, 1.3%), aceclofenac (1 case, 0.4%), ketoprofen (1 case, 0.4%) and other NSAIDs (14 cases, 7.75 %)], diuretics (2 patients, 0.9%).
The most common clinical manifestations of 232 cases were a) skin (100%) as palpable purpura (83.2%), erythema (3.0%), bullous (3.4%), ulcers (2.2 %), urticaria (3.0%) and other (5.2%). b) Digestive (88 cases, 37.5%), abdominal pain (34.1%), nausea and vomiting (12.1%) and gastrointestinal bleeding (melena, hematochezia, or positive stool Guaiac test) (7.7%). c) joint symptoms (117 cases, 50%), arthritis (14.6%). d) Fever (56 cases, 23.3%). e) nephropathy (80 cases, 33.6%), 29 of them associated with renal insufficiency.
The main laboratory data were ESR (41.0%), leukocytosis (24.6%), anemia (18.1%), positive rheumatoid factor (17.9% of 123 cases tested), positive ANA (21.1% of 128 cases tested), low C3 and / or C4 (4.4% of 128 cases tested), cryoglobulin positive (26.4% of 72 cases tested) and ANCA positive (4.8% of 62 cases tested). In case of positive immunological tests they were at low titers and no patient in the folow-up developed a connective tissue disease or a systemic necrotizing vasculitis.
Besides precipitating drug suspension and rest, in 102 patients (43.9%) was used the following pharmacological treatment: corticosteroids (67 cases, 28.9%), azathioprine (1 case), cyclophosphamide (4).
After a mean follow up of 25.4±3.4 months, relapses were observed in 18.1% of patients, chronic persistent microhematuria (4 cases) and mild (7 cases).
Conclusions Drugs mainly produce cutaneous vasculitis, although it may have systemic involvement it is usually mild. The final outcome is benign.
Acknowledgements This study was supported by grants from “Fondo de Investigaciones Sanitarias”PI12/00193 (Spain). This work was also partially supported by RETICS Program, RD08/0075 (RIER) from “Instituto de Salud Carlos III” (ISCIII) (Spain).
Disclosure of Interest None Declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.