Purpura drug-induced

Lemer, W. et al, Drug-dependent and non-drug-dependent antiplatelet antibody in drug-induced immunologic thrombocytopenic purpura, Blood, 66, 306, 1985. 

Hypersensitivity or idiosyncrasy to quinidine or other cinchona derivatives manifested by thrombocytopenia, skin eruption or febrile reactions myasthenia gravis history of thrombocytopenic purpura associated with quinidine administration digitalis intoxication manifested by arrhythmias or AV conduction disorders complete heart block left bundle branch block or other severe intraventricular conduction defects exhibiting marked QRS widening or bizarre complexes complete AV block with an AV nodal or idioventricular pacemaker aberrant ectopic impulses and abnormal rhythms due to escape mechanisms history of drug-induced torsade de pointes history of long QT syndrome. 

Kozakova M. Liekova purpura po antidepresivach. [Drug-induced purpura due to antidepressive drugs.] Cesk 128. Dermatol 1971 46(4) 158-60. 

Acute thrombocytopenic purpura has been reported in three patients given contrast agents (SEDA-11, 413). Severe thrombocytopenia has rarely been reported after iopanoic acid (128), iocetamic acid (129), and sodium iopo-date in the last case there was evidence that the patient had developed platelet antibodies of the type associated with other drug-induced thrombocytopenias (130). 

Dioti J.S, Danielson CF, Blue-Flindy DE, McCarthy LJ Drug-induced thrombotic thrombocytopenic purpura/hemolytic uremic syndrome. A concise review.Ther. Apher.2004 8 102-111... 

DIott JS, Danielson CE, Blue-FI nidy DE, and McCarthy LJ. 2004. Drug-induced thrombotic thrombocytopenic purpura/hemolytic uremic syndrome a concise review. TherApherDial8 102-111. 

Thrombocytopenia. Abnormal decrease in the number of thrombocytes below normal values. Frequently detected in patients with autoimmune diseases (e.g. systemic lupus erythematosus, -Sjogren syndrome, mixed connective tissue disease, antiphospholipid syndrome). Primary forms may be drug induced ( - heparin-induced thrombocytopenia) or mediated by antiplatelet antibodies ( - idiopathic thrombocytopenic purpura). 

The form of purpura noted under the first heading is dealt with in the section on allergic vasculitis. Drug-induced thrombocytopenic purpure is of allergic na-... 

Occasionally, hemolytic crises are described in patients with deficiency of glu-cose-6-phosphate dehydrogenase under therapy with nalidixic acid. In rare cases, thrombocytopenic purpura or hemorrhagic enteritis has been observed (Traut-MANN and Opitz 1973). Arthralgia is sometimes described after nalidixic acid, and is thought to be of allergic origin. The joint involvement is occasionally associated with exanthema or fever (Bailey et al. 1972). Rubinstein (1979) describes a case of drug-induced lupus erythematosus after nalidixic acid. 

Weintraub RM, Pechet L, Alexanjder B (1962) Rapid diagnosis of drug-induced thrombocytopenic purpura. JAMA 180 528-532... 

Hematologic Drug-induced immune thrombocytopenia can occur after exposure to many medications and is sometimes indistinguishable from idiopathic thrombocytopenic purpura. When it is suspected. 

Okawada, N., Yachi, M., Kajio, T., Urano, H. and Eto, M. (1976) Drug induced purpura. Report of a case and thrombocyte count following intravenous fluorescein (Japanese). Jap. J. din. Ophthal, 30,103. 

Another type of autoantibody leading to thrombocytopenia that is induced by ti-clopidine is directed against von Willebrand factor metalloproteinase [45 ]. This prevents the normal clearance of large multimers of von Willebrand this can lead to platelet aggregation, and in some cases, to thrombotic thrombocytopenic purpura, commonly referred to as TTP. Many other drugs have been implicated as cases of TTP, but the mechanism is unclear and appears to differ with different drugs [46],... 

Certain autoimmune syndromes can be induced by drugs. Examples include systemic lupus erythematosus following hydralazine or procainamide therapy, "lupoid hepatitis" due to cathartic sensitivity, autoimmune hemolytic anemia resulting from methyldopa administration, thrombocytopenic purpura due to quinidine, and agranulocytosis due to a variety of drugs. As indicated in other... 

Rarely reported hematological reactions to various neuroleptic drugs include agranulocytosis, thrombocytopenic purpura, hemolytic anemia, leukopenia, and eosinophilia. These are thought to represent allergic or hypersensitivity reactions, although this has been questioned in one detailed case report of chlorpromazine-induced agranulocytosis (514). 

Antazoline-induced thrombocytopenic purpura occurred on three occasions in a 21-year-old woman (2). After withdrawal of the drug she recovered promptly. In vitro investigations showed the presence of an antibody in her serum, which in association with antazoline caused complement fixation when added to test platelets. Platelet agglutinins were also detected in her serum when antazoline was added. 

Type II, or cytolytic, reactions are mediated by both IgG and IgM antibodies and usually are attributed to their ability to activate the complement systerrr The major target tissues for cytolytic reactions are the cells in the circulatory system. Examples of type II allergic responses include penicillin-inhemolytic anemia, methyldopa-indMced autoimmune hemolytic anemia, quinidine-induced thrombocytopenic purpura, and sulfonamide-induced granulocytopenia. These autoimmune reactions to drugs usually subside within several months after removal of the offending agent. 

With the introduction of RiF in 1967, the duration of combination therapy for the treatment of TB was significantiy reduced (from 18 to 9 months). Rifampin is nearly always used in combination with one or more other antitubercuiin agents. The drug is potentially hepatotoxic and may produce Gl disturbances, rash, and thrombocytopenic purpura. Rifampin is known to induce hepatic microsomai enzymes (cytochrome P450) and may decrease the effectiveness of oral contraceptives, corticosteroids, warfarin, quinidine, methadone, zidovudine, clarithromycin, and the azoie antifungai agents (see Chapter 10) (33). 

Following the fundamental investigations of Ackroyd (Dausset et al. 1964) on Se-dormid-induced thrombocytopenic purpura, numerous publications reported similar effects induced by a large variety of drugs. Several methods have been devized to establish the diagnosis. 

Hartl PW (1973) In Girwood RH (ed) Blood disorders due to drugs and other agents. Ex-cerpta Medica, Amsterdam London New York Helmly RB, Bergin JJ, Shulman NR (1967) Quinine-induced purpura. Arch Intern Med... 

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