Vasculitis drug-induced

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-... 

Propranolol Procainamide Pyrithioxine Autoimmunity Autoimmunity, drug-induced SLE, rash, vasculitis, myalgias Pemphigus... 

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... 

The spectrum of Systemic Lupus Erythematosus (SLE) includes latent lupus, discoid lupus, drug-induced lupus, neonatal lupus, lupus profundus, neuropsychiatric lupus, lupus vasculitis, pulmonary lupus, etc. The disease course is characterized by unpredictable exacerbations, drug-induced remissions and spontaneous remissions. SLE is characterized by a wide range of variable individual clinical manifestations which are controllable at early stages. 

The drugs inducing serum sickness are sulfonamides, penicillin etc. Sulfonamides also cause Stevens-Johnson syndrome, a form of immune vasculitis, which is characterized by the reactions including arthritis, nephritis, myocarditis and certain mental symptoms. 

The possible drug-induced causes of ANCA-positive vasculitis with high titers of antimyeloperoxidase antibodies in 30 new patients have been reviewed (65). The findings illustrated that this type of vasculitis is a predominantly drug-induced disorder. Only 12 of the 30 cases were not related to a drug. The most frequently implicated drug was hydralazine (n = 10) the remainder involved propylthiouracil (n = 3), penicillamine (n = 2), allopurinol (n = 2), and sulfasalazine (n = 1). 

Morita S, Ueda Y, Eguchi K. Anti-thyroid drug-induced ANCA-associated vasculitis a case report and review of the literature. Endocr J 2000 47(4) 467-70. 

In a placebo-controlled study in 48 patients with active rheumatoid arthritis, CD4 blockade produced clinical benefit (5). Adverse events were reported in 97% of the patients, compared with 73% of those given placebo. In both groups most of the events were mild to moderate. Serious adverse events were reported in five patients who received anti-CD4 syncope/vasovagal attacks (n = 3), back pain (n = 1), abdominal pain/rectal bleeding (n = 1). Skin rashes occurred in 62% of the patients who received the antibody. In five cases a skin biopsy was performed, and showed a cellular infiltration centered on the blood vessels, suggesting a drug-induced vasculitis. 

Sen S, Bayrak R, Ok E, Basdemir G. Drug-induced acute interstitial nephritisand vasculitis or vasculary rejection in renal allografts. Am J Kidney Dis. 2001 Jan 37(l) E4. 

Other drug-induced cutaneous reactions - erythema multiforme, erythema nodosum, fixed eruption, necrotizing vasculitis, and others - can have a prominent purpuric component. 

Drug-induced cutaneous necrotizing vasculitis, a clinicopathologic process characterized by inflammation and necrosis of blood vessels, often presents with a variety of small, palpable purpuric lesions most frequently distributed over the lower extremities urticaria-like lesions, small ulcerations, and occasional hemorrhagic vesicles and pustules. The basic process involves an immunologically mediated response to antigens that result in vessel wall damage. 

Cuellar ML. Drug-induced vasculitis. Curr Rheumatol Rep 2002 4 55-59. 

Symptoms can occur within hours of drug administration or after more than 15 years of using a drug. Most classes of medications have been reported to cause vascuhtis. There are no specific diagnostic tests for drug-induced vascuhtis. Antineutrophil cytoplasmic autoantihodies have been identified in many cases of drug-induced vasculitis. Eosinophiha, leukocytosis, and elevated ESR also may occur. 

The first step in therapy of drug-induced vasculitis is to discontinue the suspected inducing agent. This may be all that is necessary to abate symptoms in mild cases. For more serious cases, corticosteroids may be used, and where life-threatening organ involvement occurs. 

Merkel PA (2001) Drug-induced vasculitis. Rheum Dis Clin North Am, 27 849-862. 

Other adverse effects are caused by immunological reactions, of which the drug-induced lupus syndrome is the most common. Hydralazine also can result in an illness that resembles serum sickness, hemolytic anemia, vasculitis, and rapidly progressive glomerulonephritis the mechanism of these autoimmune reactions is unknown. The drug-induced lupus syndrome usually occurs after at least 6 months of continuous treatment with hydralazine, and its incidence is related to dose, sex,... 

C. Type III Drug Allergy Type III hypersensitivity is a complex type of drug allergy reaction that involves complement-fixing IgM or IgG antib ies and—possibly—IgE antibodies. Drug-induced serum sickness and vasculitis are examples of type III reactions Stevens-Johnson syndrome (associated with sulfonamide therapy) may also result from type III mechanisms. 

---