Drug-induced vasculitis

Background

Pathophysiology

• Unclear, but likely involves immune complex deposition

Etiology

• Minocycline: p-ANCA vasculitis similar to PAN
• Rifampin: cutaneous vasculitis
• Penicillins: cutaneous or visceral vasculitis similar to PAN
• Sulfonamides: vasculitis similar to PAN
• Fluoroquinolones: vasculitis
• Long list: ofloxacin, ciprofloxacin, lomefloxacin, tetracycline, imipenem/cilastatin, cefaclor, cefuroxime, vancomycin, teicoplanin, clarithromycin, azithromycin/roxithromycin, rifampin, TMP/SMX, nitrofurantoin, mefloquine, piperazine

Clinical Manifestations

• Most commonly starts after 4 to 7 days of exposure
• Most common presenting complaint is palpable purpura (84%), mainly in the lower extremities
  • Other dermatologic manifestations include maculopapular rash (25%) and urticaria or nodules (1% each)
• Also common is acute arthritis (65%), mainly an oligoarthritis in the legs (ankles and knees)
• May have fever (23%)
• May have nephropathy (7%), but usually mild
• May have positive ANCA antibodies

Management

• Generally self-limited following withdrawal of offending medication
• NSAIDs if symptomatic arthritis
• Occasionally prednisone
• Although unclear, should probably not be challenged with other medication in the same class

Further Reading

• Martinez-Taboada VM, et al. Clinical Features and Outcome of 95 Patients With Hypersensitivity Vasculitis. Am J Med. 1997;107(2):186-191. DOI: 10.1016/S0002-9343(96)00405-6
• ten Holder SM, Joy MS, Falk RJ. Cutaneous and Systemic Manifestations of Drug-Induced Vasculitis. Ann Pharmacother. 2002;36:130-147. DOI: 10.1345/aph.1A124