Drug-associated cutaneous vasculitis: study of 239 patients from a single referral center.

Abstract

OBJECTIVE:

The 2012 International Chapel Hill Consensus Conference on the Nomenclature of Vasculitides defined drug-associated immune complex vasculitis as a distinct entity included within the category of vasculitis associated with probable etiology. In the present study we assessed the clinical spectrum of patients with drug-associated cutaneous vasculitis (DACV).

METHODS:

Case records were reviewed of patients with DACV treated at a tertiary referral hospital over a 36-year period. A diagnosis of DACV was considered if the drug was taken within a week before the onset of the disease.

RESULTS:

From a series of 773 unselected cutaneous vasculitis cases, 239 patients (30.9%; 133 men and 106 women; mean age 36 yrs) were diagnosed with DACV. Antibiotics (n=149; 62.3%), mainly β-lactams and nonsteroidal antiinflammatory drugs (NSAID; n=24; 10%) were the most common drugs. Besides skin lesions (100%), the most common clinical features were joint (51%) and gastrointestinal (38.1%) manifestations, nephropathy (34.7%), and fever (23.8%). The most remarkable laboratory data were increased erythrocyte sedimentation rate (40.2%), presence of serum cryoglobulins (26%), leukocytosis (24.7%), positive antinuclear antibodies (21.1%), anemia (18.8%), and positive rheumatoid factor (17.5%). Despite drug discontinuation and bed rest, 108 patients (45.2%) required medical treatment, mainly corticosteroids (n=71) or immunosuppressive drugs (n=7). After a median followup of 5 months, relapses occurred in 18.4% of patients, and persistent microhematuria or renal insufficiency in 3.3% and 5%, respectively.

CONCLUSION:

DACV is generally associated with antibiotics and NSAID. In most cases it has a favorable prognosis, although a small percentage of patients may develop residual renal damage.

• Authors: Francisco Ortiz-Sanjuán, Ricardo Blanco, José L Hernández, Trinitario Pina, María C González-Vela, Héctor Fernández-Llaca, Vanesa Calvo-Río, Javier Loricera, Susana Armesto, Marcos A González-López, Javier Rueda-Gotor, Miguel A González-Gay
• Journal: The Journal of rheumatology (J Rheumatol) Vol. 41 Issue 11 Pg. 2201-7 (Nov 2014) ISSN: 0315-162X [Print] Canada
• PMID: 25225278 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents
• Anti-Inflammatory Agents, Non-Steroidal

Topics

• Adult
• Age Distribution
• Aged
• Anti-Bacterial Agents (administration & dosage, adverse effects, pharmacology)
• Anti-Inflammatory Agents, Non-Steroidal (administration & dosage, adverse effects, pharmacology)
• Biopsy, Needle
• Cohort Studies
• Female
• Humans
• Immunohistochemistry
• Incidence
• Male
• Middle Aged
• Prognosis
• Referral and Consultation
• Retrospective Studies
• Severity of Illness Index
• Sex Distribution
• Statistics, Nonparametric
• Tertiary Care Centers
• Vasculitis (chemically induced, epidemiology, pathology)
• Young Adult