Drug-induced vasculitis
From IDWiki
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
