Hypersensitivity angiitis

Immune vasculitis can also be induced by drugs. The sulfonamides, penicillin, thiouracil, anticonvulsants, and iodides have all been implicated in the initiation of hypersensitivity angiitis. Erythema multiforme is a relatively mild vasculitic skin disorder that may be secondary to drug hypersensitivity. Stevens-Johnson syndrome is probably a more severe form of this hypersensitivity reaction and consists of erythema multiforme, arthritis, nephritis, central nervous system abnormalities, and myocarditis. It has frequently been associated with sulfonamide therapy. Administration of nonhuman monoclonal or polyclonal antibodies such as rattlesnake antivenin may cause serum sickness. 

Lin RY. Unusual autoimmune manifestations in furosemide-associated hypersensitivity angiitis. NY State J Med 1988 88(8) 439-40. 

Acute lung reactions to nitrofurantoin are extremely rare in children (12). Lung tissue findings in acute reactions have shown minor vasculitis, granulomatous vasculitis (hypersensitivity angiitis), proliferation of endothelial cells, and empty alveoli (13). Rapidly progressing bronchiolitis obliterans with organizing pneumonia (BOOP) has been reported (14). 

Reijula K, Sutinen S, Tuuponen T, Lahti R, Karkola P Pulmonary fibrosis, with sarcoid granulomas and angiitis, associated with handling of mouldy lichen. Eur J Respir Dis 1983 64 625-629. Yoshida K, Ueda A, Yamasaki H, Sato K, Uchida K, Ando M Hypersensitivity pneumonitis resrrlt-ing from A. fumigatus in a greenhouse. Arch Environ Health 1993 48 260-262. 

Respiratory reactions to sulfonamides include migratory pulmonary infiltrates, chronic pneumonia, asthma, and pulmonary angiitis. These reactions are thought to be mainly due to hypersensitivity, although the precise mechanisms are not well understood (14-16). The link to the drug has been proven in most cases by recurrence after re-exposure to the same sulfonamide or to co-trimoxazole. 

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