The second case in the medical literature of
hypersensitivity vasculitis induced by
glybenclamide is reported, and for the first time vasculitic lesions are demonstrated in the histopathological study of liver tissue. The case was a male patient admitted because of a febrile illness and generalized malaise of long duration. He had
diabetes mellitus that was being treated with
glybenclamide. Physical examination disclosed
fever, poor general condition,
hepatomegaly, and red nodes in the finger-
tips of both hands. Abnormal laboratory parameters included normochromic normocytic
anemia,
leukocytosis with a high eosinophil count, and markedly elevated erythrocyte sedimentation rate. There was as well slight cytolysis and marked elevation of cholestatic serum
enzymes without
hyperbilirubinemia. Biopsy of the skin lesions demonstrated anular granulomata, a common lesion in diabetics. The histopathological study of the liver revealed a vasculitic
hypersensitivity reaction with conspicuous granulomata located in the vicinity of blood vessels and in the wall of portal arterioles, the endothelium of the latter being disrupted at different levels.
Glybenclamide withdrawal resulted in a clinical,
biological and histopathological cure of the disease. Unlike the previously reported case, the patient remains alive, and this may partly have been due to early institution of
corticosteroid therapy.