The pathogenesis of druginduced anca associated vasculitis might be multifactorial. The course of druginducedvasculitis is better than idiopathic vasculitis, in which the discontinuation of the responsible drug is usually sufficient. Request pdf druginduced vasculitis druginduced vasculitis is defined as inflammation of blood vessels due to an adverse effect of a drug. Ptuinduced autoimmune syndromes can be classified into druginduced lupus dil or druginduced vasculitis div based on definitions, clinical features, and serological features 4. Based on our understanding of the disease, the 2012 international chapel hill consensus conference classified druginduced aav as vasculitis associated with probable etiology. Smallvessel vasculitis svv with leukocytoclastic histopathology is usually described in druginduced vasculitis.
Although drugs are the most common cause, drug induced vasculitis is a poorly defined disorder. Vasculitis is a group of disorders that destroy blood vessels by inflammation. Druginduced vasculitis is the commonest cause of vasculitis in adults. Druginduced antineutrophil cytoplasmic antibodies ancaassociated vasculitis has been classically associated with cocaine alone or. There are many potential causes of hypersensitivity vasculitis. The clinical phenotypes vary from single tissue or organ involvement to severe systemic inflammatory disease dominated. We also focused on the differences between druginduced aav and primary vasculitis. The medline database was searched from 1965 to december 1999 for articles focusing on drugs and vasculitis, using various search terminologies e. Amongst antithyroid drugs, methimazole mmi is rarely implicated as a culprit drug. Leukocytoclastic vasculitis a subtype of druginduced vasculitis often presents itself with palpable purpuric lesions, and often within weeks of. Hypersensitivity vasculitis, which is usually represented histopathologically as leukocytoclastic vasculitis lcv, is a term commonly used to denote a smallvessel vasculitis.
The medline database was searched from 1965 to december 1999 for articles. Traditionally, druginduced aav has only been understood as a class of div characterized by anca positive. As the use of icis expand, immunemediated adverse events are becoming a common occurrence. Patients with druginduced vasculitis may have similar clinical presentations to patients with idiopathic vasculitis. Pdf druginduced cutaneous vasculitides researchgate. Henochschonlein purpura cryoglobulinemia hypocomplementemic urticarial vasculitis vasculitis associated with sle, rhuematoid arthritis, or other autoimmune diseases serumsickness or drug induced vasculitis classification of vasculitis. From the consensus conference for the nomenclature of systemic vasculitis, chapel hill, north carolina, usa 31 and ferro 11. Malignancyrelated vasculitis illicit druginduced vasculitis table 1. Patients with urticarial vasculitis present with an urticarial eruption, often accompanied by a painful or burning sensation. Ancaassociated smallvessel vasculitis is the most common primary type in adults. The american college of rheumatology established a list of criteria for the classification of. A variety of agents may produce a typical clinical picture together with a similar autoimmune profile, suggesting a common mechanism for druginduced vasculitis. Ceftriaxoneinduced leucocytoclastic vasculitis bmj case. An approach to diagnosis and initial management of systemic vasculitis.
At the time, a thyroid function test revealed a free t3 of 6. A typical feature of smallvessel vasculitis svv induced by drugs is the presence of antineutrophil cytoplasmic antibodies anca in a significant proportion, which may have specificity toward proteinase3 antipr3. Eosinophilic granulomatosis with polyangiitis 2 drugs granulomatosis with polyangiitis 6 drugs. A novel cutaneous vasculitis syndrome induced by levamisolecontaminated cocaine.
While rashes are common with many drugs, a diagnosis of drug. To evaluate the literature for published cases of druginduced vasculitis with cutaneous andor systemic manifestations. Hypersensitivity to a drug or foreign agent leads to a skin disorder with inflammation and damage to blood vessels of the skin. Hydralazineinduced antineutrophil cytoplasmic antibody. Anca positivity can be associated with both idiopathic and druginduced vasculitis. Druginduced skin reactions are common, but only a small portion 10% are attributed to a vasculitic mechanism.
Similarly, there is no clear definition of druginduced aav. However, there are many other triggers including, but not limited to, infections, neoplasms, inflammatory disorders, and druginduced vasculitis. Nonclinical safety biomarkers of druginduced vascular. Druginduced vasculitis misra dp, patro p, sharma a indian j.
It usually occurs within weeks after a drug is started. I read with interest the article titled relapsing leukocytoclastic vasculitis triggered by activity in a young woman. There are many types of vasculitis, and they may vary greatly in symptoms, severity and duration. Cutaneous and systemic manifestations of druginduced vasculitis.
Leukocytoclastic vasculitis hypersensitivity vasculitis. Druginduced antineutrophil cytoplasmic antibodyassociated. Immune check point inhibitors icis have emerged as a new therapeutic paradigm for a variety of malignancies including metastatic melanoma. An approach to diagnosis and initial management of. Over the years, multiple other agents have been linked to immunemediated glomerular disease, often with associated autoantibody formation. Antineutrophil cytoplasmic antibody ancaassociated vasculitis aav affects systemic small vessels and is accompanied by the presence of ancas in the serum. Features of this association include the presence of high titres of antimyeloperoxidaseantineutrophil cytoplasmic antibody with multiantigenicity. It is also very difficult to prove that an exposure to a drug led to cutaneous vasculitis. Methimazoleinduced antineutrophil cytoplasmic antibody. Summary a recent development in the field of vasculitis is the. The diagnosis of druginduced vasculitis is based on the temporal relationship between clinically evident vasculitis and drug administration, with exclusion of other conditions that mimic vasculitis or other types of vasculitis. Druginduced vasculitis and druginduced lupuslike disease are seen in patients treated long term with a drug, and close to 100 drugs representing all pharmacologic classes have been assumed capable of inducing such syndromes. Differentiating druginduced from the idiopathic vasculitis syndromes can be challenging.
Cutaneous lesions in the majority of patients with druginduced vasculitis usually present on the lower extremities as shown in fig. Histologically, vasculitis is defined as an inflammatory cellmediated infiltration and destruction of blood vessels. Hypersensitivity vasculitis hv is often used to describe different types of vasculitis related to drug reactions, skin disorders or allergic vasculitis. Vasculitis causes changes in the walls of blood vessels, including thickening, weakening, narrowing and scarring. Leukocytoclastic vasculitis is also referred as hypersensitivity vasculitis or hypersensitivity angiitis. Recurrent purpura with symptom free intervals can be seen in the setting of hsp or other. Ancaassociated druginduced vasculitis is a type of small vessel vasculitis that is commonly associated with constitutional symptoms, arthralgias and skin involvement. Druginduced vasculitides 129 druginduced lupus in principle, this condition has little in common with hypersensitivity vasculitis, which does not test positive for antinuclear antibodies, has different skin lesions and requires a much shorter exposure to the drug cohen and prowse, 1989. Tissue eosinophilia as an indicator of druginduced. Vasculitis is primarily caused by leukocyte migration and resultant damage although both occur in vasculitis, inflammation of veins or arteries on their own are separate entities. Druginduced vasculitis is an inflammation of blood vessels caused by the use of various pharmaceutical agents.
However, in some cases it can be more severe, and also involve the kidneys and lungs. Most types of vasculitis are rare, and the causes are generally not known. Cutaneous and systemic manifestations of druginduced. Objectiveto determine whether tissue eosinophilia is a reliable indicator of a druginduced etiology in biopsy samples demonstrating leukocytoclastic vasculitis. The skin is the most commonly affected organ in druginduced vasculitis, and can range from involvement of small vessels arterioles, capillaries, and venules to more severe disease affecting small to mediumsized arteries. A pragmatic approach to vasculitis in the gastrointestinal. Druginduced vasculitis druginduced vasculitis cuellar, marta 20020524 00. Exerciseinduced vasculitis lifestyle behaviors jama. Hv may be caused by a specific drug or occur in association with an infection, but it may also be idiopathic, meaning there is no known cause. Lesions are generalized wheals or erythematous plaques, occasionally with central clearing, lasting for more than 24 hours in a fixed location in contrast to urticaria, which resolves in minutes to hours or migrates continually. Characteristic purpura of the ears, vasculitis, and neutropeniaa potential public health epidemic associated with levamisoleadulterated cocaine. When only the small capillary vessels are involved, it is also called exerciseinduced. Exerciseinduced vasculitis is a harmless form of cutaneous small vessel vasculitis.
To date, the mechanism is far from fully understood and it might be multifactorial. It is a neutrophilic inflammatory disorder involving the small or mediumsized blood vessels of the skin and subcutaneous tissue. The nomenclature of cutaneous small vessel vasculitis csvv is diverse and often confusing. Smallvessel vasculitis druginduced smallvessel involvement may result in cutaneous vasculitis alone or also involve internal organs such as the kidney and peripheral nerves. Druginduced vasculitis misra dp, patro p, sharma a. A few cases of druginduced vasculitis presenting with a hemorrhagic syndrome due to lung capillaritis have been reported. Drugs found to be most frequently associated with vasculitis were propylthiouracil, hydralazine, colonystimulating factors, allopurinol, cefaclor, minocycline, d. Druginduced vasculitis, current rheumatology reports 10. Henochschonlein purpura cryoglobulinemia hypocomplementemic urticarial vasculitis vasculitis associated with sle, rhuematoid arthritis, or other autoimmune diseases serumsickness or druginduced vasculitis classification of vasculitis.
Druginduced vasculitis is typically a smallvessel vasculitis with leucocytoclasia and fibrinoid necrosis. Druginduced vasculitis is a rare adverse drug reaction and the potential to induce such a reaction is often established postmarketing. Druginduced vasculitis can be defined as any type of inflammatory vascular disorder caused by administration of a pharmacologic agent. We describe the first reported patient with small vessel vasculitis, manifested by digital ischemia, following treatment with high dose ipilimumab for. The occurrence of druginduced vascular injury divi is a significant cause of termination of candidate drugs in nonclinical assessment of safety, especially for vasoactive compounds, antineoplastic agents, and biotherapeutics. Key clinical features of leukocytoclastic vasculitis include palpable purpura, lower extremity location, small vessel involvement, and extracutaneous involvement in approximately 30% of patients. Diagnosis and treatment of cutaneous leukocytoclastic.
In recent years, an increasing number of drugs have been proved to be associated with the induction of antineutrophil cytoplasmic antibody ancaassociated vasculitis aav. Druginduced vasculitis patients typically harbor anca directed to one or more neutrophil cytoplasm antigens, the most common antigens being the granule proteins mpo, hle, cathepsin g, and lactoferrin. Notably, the most crucial step in the management of druginduced leukocytoclastic vasculitis is the discontinuation of the offending. Objective to determine whether tissue eosinophilia is a reliable indicator of a druginduced etiology in biopsy samples demonstrating leukocytoclastic vasculitis. A 35yearold man without history of drug allergy and a medical history of essential hypertension, intravenous drug abuse, and chronic hepatitis c with low viral load presented for evaluation with a 5day rash in lower extremities associated with crimpling joint pain. The spot is caused by the bleeding beneath the skin which in turn causes the reddish or purplish discoloration of the skin. Druginduced autoimmune disease was initially described decades ago, with reports of vasculitis and a lupuslike syndrome in patients taking hydralazine, procainamide, and sulfadiazine. Vasculitis is a term for a group of rare diseases that have in common inflammation of blood vessels. Pathogenesis and therapeutic interventions for anca.
Leukocytoclastic vasculitis pictures, causes and treatment. Cutaneous smallvessel vasculitis csvv, also known as hypersensitivity vasculitis, cutaneous leukocytoclastic vasculitis, hypersensitivity angiitis, cutaneous leukocytoclastic angiitis, cutaneous necrotizing vasculitis and cutaneous necrotizing venulitis, is inflammation of small blood vessels usually postcapillary venules in the dermis, characterized by palpable purpura. Many of autoimmune diseases including systemic lupus erythematosus sle, dil, div, and idiopathic antineutrophil cytoplasm antibody anca. Diagnosis of druginduced vasculitis is often challenging, as there are no pathognomonic clinical or histological features to distinguish it from other causes of vasculitis. The pathogenesis of druginduced vasculitis is unclear. Hydralazineinduced antineutrophil cytoplasmic antibodypositive renal vasculitis is a rare adverse effect and can present with a severe vasculitic syndrome with multiple organ involvement. Tissue eosinophilia as an indicator of druginduced cutaneous. Severity of druginduced vasculitis can range from mild, and selflimiting to.
142 672 879 413 236 444 1326 1450 1161 125 972 1072 1161 558 385 1247 1348 830 1137 982 764 1244 1393 1402 927 224 1021 4 1383 736 4 1198 823 1231 1105 1376 336 1386 624 926