Cutaneous vasculitis

Ramos-Casals, M., Anaya, J. M., Garcia-Carrasco, M. et al. Cutaneous vasculitis in primary Sjogren syndrome classification and clinical significance of 52 patients. Medicine (Baltimore) 83 96-106, 2004. 

Hypersensitivity reactions, such as pruritus, cutaneous vasculitis, and thrombocytopenia, are seen in some patients, and an immune-mediated systemic flulike syndrome with thrombocytopenia also has been described. Rifampin imparts a harmless red-orange color to urine, feces, saliva, sweat, tears, and contact lenses. Patients should be advised of such discoloration of body fluids. 

Filgrastim is administered by intravenous infusion or subcutaneous injection. The doses given are 1-20 pg/kg per day over at least a 30-min period. Generally a dose of 5 pg/kg is used in patients receiving chemotherapy for 14-21 days or longer. The half-life of the drug is 3.5 h. The side effects include bone pain, local skin reactions and rarely cutaneous vasculitis. 

Cutaneous vasculitis is often a feature of such cases, although severe systemic manifestations often also occur. Two patients with propylthiouracil hypersensitivity presented with skin manifestations but also had renal, rheu-matological, and hematological features (66). A review of the literature showed that the symptoms and signs in patients with ANCA-associated thionamide-induced vasculitis are diverse. Acral purpuric skin lesions are typically seen recognition of these classical clinical features may allow early diagnosis and limit associated morbidity and the requirement for other therapies, particularly immunosuppression. Several other reports have described... 

M12. McDuffie, F. C., Sams, W. M., Maldonado, J. E., Andreini, P. H., Conn, D. L., and Samayoa, E. A., Hypocomplementemia with cutaneous vasculitis and arthritis. Possible immune complex syndrome. Mayo Clin. Proc. 48, 340-348 (1973). 

Skin rashes are so common that it is difficult to determine a cause-and-effect relation. A choice must be made between waiting to see if the rash clears despite continued treatment or switching to a different compound and, if necessary, rechallenging at a later date. Serious reported skin reactions include cutaneous vasculitis, urticaria, and... 

Margolese HC, Chouinard G, Beauclair L, Rubino M. Cutaneous vasculitis induced by paroxetine. Am J Psychiatry 2001 158(3) 497. 

Dan, M., Yaniv, R. Cholestatic hepatitis, cutaneous vasculitis, and vascular deposits of immunoglobulin M and complement associated with hepatitis A virus infection. Amer. J. Med. 1990 89 103-104... 

Schwartz MS, Frank MS, Yanoff A, Morecki R. Atenolol-associated cholestasis. Am J Gastroenterol 1989 84(9) 1084-6. Wolf R, Ophir J, Elman M, Krakowski A. Atenolol-induced cutaneous vasculitis. Cutis 1989 43(3) 231-3. 

A progressive cutaneous vasculitis occurred in a 66-year-old man taking sotalol for prevention of a symptomatic atrial fibrillation. After 7 days he noted a petechial eruption on his wrists and ankles. This progressed during the next days to palpable purpura on the hands, wrists, ankles, and feet. A biopsy specimen showed changes consistent with leukocytoclastic vasculitis. After withdrawal of sotalol the skin rash cleared completely without any other intervention. 

Mitchell GG, Magnusson AR, Weiler JM. Cimetidine-induced cutaneous vasculitis. Am J Med 1983 75(5) 875-6. 

Ciprofloxacin can cause a fixed drug eruption (43,44), purpuric skin lesions (44,45), bullous pemphigoid (46), cutaneous vasculitis (45-47), and ultraviolet recall-like phenomenon (48). 

Perez Vazquez A, Gutierrez Perez B, Carreter de Granda E, Zuniga Perez-Lemaur M, Conde Yague R. Vasculitis cutanea por ciprofloxacino. [Cutaneous vasculitis caused by ciprofloxacin.] An Med Interna 2000 17(4) 225. 

Skowron F, Berard F, Bernard N, Balme B, Perrot H. Cutaneous vasculitis related to celecoxib. Dermatology 2002 204(4) 305. 

Cutaneous vasculitis (12) and angioedema (13,14) have been reported with diltiazem. In 1988, the Federal German Health Authorities imposed a warning of dermal hypersensitivity reactions (including erythema multiforme) with diltiazem. 

Sheehan-Dare RA, Goodfield MJ. Widespread cutaneous vasculitis associated with diltiazem. Postgrad Med J 1988 64(752) 467-8. 

There have been several descriptions of new cutaneous or pulmonary nodulosis in patients with rheumatoid arthritis treated with etanercept (4,18) concomitant cutaneous vasculitis was also reported in two patients (18). Although this may have been due to the natural history of rheumatoid arthritis or a lack of response to treatment, the short time to the occurrence of cutaneous nodulosis after the start of therapy in some patients implicated the etanercept. 

Cutaneous vasculitis can also be the sole cutaneous manifestation of etanercept treatment (19). Purpuric lesions with histological features of leukocytoclastic... 

Livermore PA, Murray KJ. Anti-tumour necrosis factor therapy associated with cutaneous vasculitis. Rheumatology (Oxford) 2002 41(12) 1450-2. 

Jain KK. Cutaneous vasculitis associated with granulocyte colony-stimulating factor. J Am Acad Dermatol 1994 31(2 Pt 1) 213-15. 

Livingood CS, Stewart RH, Webster SB. Cutaneous vasculitis caused by griseofulvin. Cutis (NY) 1970 6 1346. 

Immunologic Pulmonary and cutaneous vasculitis F 45 1 2 days 1 week... 

Cutaneous vasculitis has been attributed to intravenous immunoglobulin (96)... 

In a patient with type II mixed cryoglobulinemia, intravenous immunoglobulin caused severe cutaneous vasculitis accompanied by an increased cryocrit (98). 

Hydralazine seems to increase the risk of acute cutaneous vasculitis in patients given iopamidol (314). 

Reynolds NJ, Wallington TB, Burton JL. Hydralazine predisposes to acute cutaneous vasculitis following urography with iopamidol. Br J Dermatol 1993 129(l) 82-5. 

The authors estimated that about 0.5% of patients treated with levamisole develop cutaneous vasculitis with circulating autoantibodies. 

Skin reactions to mefloquine have been reviewed, in relation to 74 case reports published between 1983 and 1997 (39). Pruritus and maculopapular rash were the most common skin reactions in some studies, their approximate frequency was 4—10% for pruritus and up to 30% for non-specific maculopapular rashes. Adverse effects less commonly associated with mefloquine included urticaria, facial lesions, and cutaneous vasculitis. There was one case of Stevens-Johnson syndrome and one fatal case of toxic epidermal necrolysis. 

The nodules can appear at any time during treatment, with or without concomitant cutaneous vasculitis, and are usually found in patients with erosive disease and a high titer of rheumatoid factor. This has raised the question as to whether they are a reason to modify treatment, and whether they are rheumatic or represent a true adverse effect of methotrexate certainly, methotrexate-associated nodulosis is very similar to idiopathic rheumatoid arthritis nodulosis and sometimes disappears despite continuation of methotrexate. However, prompt regression on methotrexate withdrawal and recurrence on rechallenge in several patients strongly argue for a causal drug-related effect. 

Fondevila Carlos G, Milone Gustavo A, Santiago P. Cutaneous vasculitis after intermediate dose of methotrexate (IDMTX). Br J Haematol 1989 72(4) 591-2. 

Allergic contact dermatitis to methoxsalen (8-methoxypsoralen) Allergic cutaneous vasculitis (SEDA-6, 146)... 

Severe skin reactions have been reported with the combination of pyrimethamine + sulfadoxine (Fansidar) from various countries. These include erythema exudativum multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, cutaneous vasculitis, lichen planus, a single case of ectodermosis pluriorificialis, and some cases of photosensitivity. 

Generalized vasculitis was reported in two cases in Sweden one developed fever, jaundice, orchitis, and gastrointestinal bleeding after 2 weeks, the other cutaneous vasculitis and rapid progressive nephritis after 3 weeks (SEDA-13, 241). 

Cutaneous vasculitis has been attributed to spironolactone (SED-11, 430). It is unclear whether a patient presenting with erythema annulare centrifugum while taking spironolactone (10) had a similar reaction. 

Cutaneous vasculitis is often a feature of such cases, although severe systemic manifestations often also occur. 

Cutaneous or mucous reactions occur in about 15-30% of patients using tiopronin. Alopecia, erythema, eczema, cutaneous vasculitis, lichenoid eruptions, skin wrinkling, or a perforating elastoma can develop (l-3,5,6). 

Skin rashes are uncommon (2-4%), and photosensitivity and cutaneous vasculitis, if they occur at all, are exceedingly rare (SED-13, 152) (91,92). 

Kamper AM, Valentijn RM, Strickler BH, Purcell PM. Cutaneous vasculitis induced by sodium valproate. Lancet 1991 337(8739) 497-8. 

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