Hypersensitivity vasculitis

Hypersensitivity vasculitis has been described with glibenclamide (127). Glibenclamide contains a sulfa moiety and can cause allergic reactions in someone who is allergic to sulfonamides. 

A hypersensitivity reaction characterized by multiple purpuric lesions and reduced renal function has been described in an elderly patient (SEDA-18, 103), and there have been reports of hypersensitivity vasculitis (SEDA-20, 91) (SEDA-21,103). 

Susano R, Garcia A, AltadiU A, Ferro J. Hypersensitivity vasculitis related to nicoumalone. BMJ 1993 306(6883) 973. 

After intramuscular iron dextran, symmetrical allergic purpura of the lower limbs due to hypersensitivity vasculitis has been observed in a child (41). 

Ong AC, Handler CE, Walker JM. Hypersensitivity vasculitis complicating intravenous streptokinase therapy in acute myocardial infarction. Int J Cardiol 1988 21(l) 71-3. 

In one case a hypersensitivity vasculitis developed 2 weeks after Varicella immunization (12). 

Alves-Rodrigues EN, Ribeiro LC, Silva MD,Takiuchi A, Rabel-Filho OC, Martini-Filho D, et al. Renal hypersensitivity vasculitis associated with dapsone. Am J Kidney Dis. 2005 Oct 46(4) e51-3. 

BoyerTD, Sun N, ReynoldsTB. Allopurinol-hypersensitivity. Vasculitis and liver damage. West J Med 1977 126 143-147. 

Henoch-Schdnlein is a type of hypersensitivity vasculitis and inflammatory response within the blood... 

Hypersensitivity vasculitis induced by drags is another manifestation of a type III response. Drags involved include some p-lactams, particularly, amoxicillin and cephalexin, cotrimoxazole, NSAIDs, monoclonal antibodies, and chemotherapeutic drags such as tamoxifen and erlotinib. A proportion of small-vessel vasculitis patients have anti-neutrophil cytoplasmic antibodies. Although there is evidence of a pathogenic role for these antibodies and they are used as a diagnostic marker, operative mechanisms underlying this hypersensitivity state are still far from established. 

Fig. 11.1 Palpable purpura in a patient with hypersensitivity vasculitis (leukocytoclastic vascuhtis), a small vessel vasculitis usually involving post-capillary venules in the dermis. This cutaneous manifestation of vasculitis occurs occasionally following treatment with mAbs and some other biologic agents (Photograph of Dr. John Stone) (Reproduced with permission from Weyand CM, Goronzy J, in Klippel JH, Stone JH, Crofford LeJ, White PH, editors. Primer on the Rheumatic Diseases, 13th ed. New York Springer, 2008)...

The patient fulfilled all the criteria of the American Association for Rheumatology for a diagnosis of a hypersensitivity vasculitis [114 ]. 

Calabrese LH, Michel BA, Bloch DA, Arend WP, Edworthy SM, Fauci AS, Fries JF, Hunder GG, Leavitt RY, Lie JT, Lightfoot Jr. RW, Masi AT, McShane DJ, Mills JA, Stevens MB, Wallace SL, Zvaifler NJ. The American College of Rheumatology 1990 criteria for the classification of hypersensitivity vasculitis. Arthritis Rheum 1990 33(8) 1108-13. 

The major side effects of allopurinol are skin rash, urticaria, leukopenia, GI problems, headache, and increased frequency of acute gouty attacks with the initiation of therapy. An allopurinol hypersensitivity syndrome characterized by fever, eosinophilia, dermatitis, vasculitis, and renal and hepatic dysfunction occurs rarely but is associated with a 20% mortality rate. 

Antibiotics Isoniazid Penicillins Hypersensitivity and Autoimmunity Rash, dermatitis, vasculitis, arthritis, drug-induced SLE Anaphylaxis, dermatitis vasculitis, serum sickness, hemolytic anemia... 

Others Acetazolamide Lithium Thiaazides Phenytoin Rash, fever, autoimmunity Dermatitis autoimmune thyroiditis, vasculitis Hypersensitivity, photosensitivity autoimmunity (diabetes) Rash drug-induced SLE, hepatitis... 

Hypersensitivity reactions Discontinue at first appearance of skin rash or other signs of allergic reactions. In some instances, rash may be followed by more severe hypersensitivity reactions such as exfoliative, urticarial or purpuric lesions, or Stevens-Johnson syndrome, generalized vasculitis, irreversible hepatotoxicity and rarely, death. 

Hypersensitivity Fever, skin eruptions of various types, including exfoliative dermatitis, infectious mononucleosis-like, or lymphoma-like syndrome, leukopenia, agranulocytosis, thrombocytopenia, Coombs positive hemolytic anemia, jaundice, hepatitis, pericarditis, hypoglycemia, optic neuritis, encephalopathy, Leoffler s syndrome, vasculitis, and a reduction in prothrombin. 

Hypersensitivity reactions Anaphylactic reactions and other allergic reactions have been reported. Cutaneous allergic reactions and serious cases of allergic vasculitis, often with purpura (bruises and red patches), of the extremities and extracutaneous P.1215... 

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. 

Contraindications Active internal bleeding, arteriovenous malformation or aneurysm, cerebrovascular accident (CVA) with residual neurologic defect, history of CVA (within the past 2 yr) or oral anticoagulant use within the past 7 days unless PT is less than 1.2 X control, history of vasculitis, hypersensitivity to murine proteins, intracranial neoplasm, prior IV dextran use before or during percutaneous transluminal coronary angioplasty (PTCA), recent surgery or trauma (within the past 6 wk), recent (within the past 6 wk or less) GI or GU bleeding, thrombocytopenia (less than 100,000 cells/pl), and severe uncontrolled hypertension... 

Adverse reactions include visual disturbances (transient, at the beginning of therapy), nausea and epigastric bloating (rare) and diarrhoea. Hypersensitivity including allergic skin reactions, thrombocytopenia, leucopenia, agranulocytosis, haemolytic anaemia, vasculitis, cholestatic jaundice and hepatitis. 

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. 

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... 

Chastain MA, Russo GG, Boh EE, Chastain JB, Falabella A, Millikan LE. Propylthiouracil hypersensitivity report of two patients with vasculitis and review of the literature. J Am Acad Dermatol 1999 41(5 Pt 1) 757-764. 

Tricyclic antidepressants rarely cause cholestatic jaundice and agranulocytosis due to hypersensitivity reactions. The rare liver necrosis may reflect severe hypersensitivity. Two fatal cases of hypersensitivity myocarditis and hepatitis have been described (1). A variety of dermatological manifestations have been reported (rash, urticaria, vasculitis), but their relation to drug ingestion is often uncertain. A single case of pulmonary hypersensitivity with... 

A case of urticarial vasculitis, a type III hypersensitivity reaction, has been reported after cocaine use (222). 

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