Cutaneous and systemic manifestations of drug-induced vasculitis

OBJECTIVE: To evaluate the literature for published cases of drug-induced vasculitis with cutaneous and/or systemic manifestations. DATA SOURCES: The MEDLINE database was searched from 1965 to December 1999 for articles focusing on drugs and vasculitis, using various search terminologies (e.g., Churg-Strauss syndrome, Goodpasture's syndrome, Henoch-Schonlein purpura, various drugs suspected to induce vasculitis). Cases were included when they met the established criteria as described in the methodology. DATA SYNTHESIS: Drugs found to be most frequently associated with vasculitis were propylthiouracil, hydralazine, colony-stimulating factors, allopurinol, cefaclor, minocycline, D-penicillamine, phenytoin, isotretinoin, and methotrexate. The interval between the first exposure and appearance of symptoms was reported to be extremely variable (hours to years). Vasculitis has occurred after drug dosage increases and after rechallenge with the suspected drug. In the majority of cases, vasculitis has resolved after discontinuing the drug. Patients with more severe, often life-threatening, manifestations have required treatment with corticosteroids, plasmapheresis, hemodialysis, or cyclophosphamide. Death was the result in 10% of all published cases, with a predominance in patients in whom multiple organ systems were involved. CONCLUSIONS: Clinicians need to be suspect of drug-induced vasculitis to enable prompt diagnosis and treatment. This should improve patient outcomes based on the data referenced for this article.

This article has been cited by other articles:

				S. Lionaki, S. L. Hogan, R. J. Falk, M. S. Joy, C. E. Jennette, J. C. Jennette, and P. H. Nachman Reply Nephrol. Dial. Transplant., June 1, 2008; 23(6): 2107 - 2108. [Full Text] [PDF]

				S. Lionaki, S. L. Hogan, R. J. Falk, M. S. Joy, C. E. Jennette, P. H. Nachman, and J. C. Jennette Vasculitis and anti-thyroid medication Nephrol. Dial. Transplant., May 1, 2008; 23(5): 1766 - 1768. [Full Text] [PDF]

				S. Lionaki, S. L. Hogan, R. J. Falk, M. S. Joy, H. Chin, C. E. Jennette, J. C. Jennette, and P. H. Nachman Association between thyroid disease and its treatment with ANCA small-vessel vasculitis: a case control study Nephrol. Dial. Transplant., December 1, 2007; 22(12): 3508 - 3515. [Abstract] [Full Text] [PDF]

				R. Chokshi, J. Openshaw, N. N Mehta, and E. Mohler III Purple glove syndrome following intravenous phenytoin administration Vascular Medicine, February 1, 2007; 12(1): 29 - 31. [Abstract] [PDF]

				J. E. Lee, C. H. Jeon, D. K. Chang, M.-S. Lee, and H. Y. Oh Henoch-Schonlein purpura associated with propylthiouracil overdose Nephrol. Dial. Transplant., August 1, 2006; 21(8): 2338 - 2339. [Full Text] [PDF]

				A. Gutierrez-Macias, E. Lizarralde-Palacios, P. Martinez-Odriozola, and F. Miguel-De la Villa Fatal allopurinol hypersensitivity syndrome after treatment of asymptomatic hyperuricaemia BMJ, September 17, 2005; 331(7517): 623 - 624. [Full Text] [PDF]

				S. Kathiresan, P. B. Kelsey, A. C. Steere, C. S. Foster, M. S. Curvelo, and J. R. Stone Case 14-2005 - A 38-Year-Old Man with Fever and Blurred Vision N. Engl. J. Med., May 12, 2005; 352(19): 2003 - 2012. [Full Text] [PDF]

				J. C Cobeta-Garcia, P. Garcia-Enguita, M. A Pina-Latorre, F. J Lerin-Sanchez, and F. Rodilla-Calvelo Ritodrine-Induced Leukocytoclastic Vasculitis in Pregnancy Ann. Pharmacother., January 1, 2004; 38(1): 66 - 69. [Abstract] [Full Text] [PDF]

				V. Palop-Larrea, M A. Melchor-Penella, C. Ortega-Monzo, and I. Martinez-Mir Leukocytoclastic vasculitis related to rofecoxib Ann. Pharmacother., November 1, 2003; 37(11): 1731 - 1732. [Full Text] [PDF]

				R. J. Falk and J. C. Jennette ANCA Are Pathogenic--Oh Yes They Are! J. Am. Soc. Nephrol., July 1, 2002; 13(7): 1977 - 1979. [Full Text] [PDF]