Drug-associated cutaneous vasculitis: study of 239 patients from a single referral center

J Rheumatol. 2014 Nov;41(11):2201-7. doi: 10.3899/jrheum.140390. Epub 2014 Sep 15.

Abstract

Objective: The 2012 International Chapel Hill Consensus Conference on the Nomenclature of Vasculitides defined drug-associated immune complex vasculitis as a distinct entity included within the category of vasculitis associated with probable etiology. In the present study we assessed the clinical spectrum of patients with drug-associated cutaneous vasculitis (DACV).

Methods: Case records were reviewed of patients with DACV treated at a tertiary referral hospital over a 36-year period. A diagnosis of DACV was considered if the drug was taken within a week before the onset of the disease.

Results: From a series of 773 unselected cutaneous vasculitis cases, 239 patients (30.9%; 133 men and 106 women; mean age 36 yrs) were diagnosed with DACV. Antibiotics (n=149; 62.3%), mainly β-lactams and nonsteroidal antiinflammatory drugs (NSAID; n=24; 10%) were the most common drugs. Besides skin lesions (100%), the most common clinical features were joint (51%) and gastrointestinal (38.1%) manifestations, nephropathy (34.7%), and fever (23.8%). The most remarkable laboratory data were increased erythrocyte sedimentation rate (40.2%), presence of serum cryoglobulins (26%), leukocytosis (24.7%), positive antinuclear antibodies (21.1%), anemia (18.8%), and positive rheumatoid factor (17.5%). Despite drug discontinuation and bed rest, 108 patients (45.2%) required medical treatment, mainly corticosteroids (n=71) or immunosuppressive drugs (n=7). After a median followup of 5 months, relapses occurred in 18.4% of patients, and persistent microhematuria or renal insufficiency in 3.3% and 5%, respectively.

Conclusion: DACV is generally associated with antibiotics and NSAID. In most cases it has a favorable prognosis, although a small percentage of patients may develop residual renal damage.

Keywords: CUTANEOUS VASCULITIS; DRUG-ASSOCIATED VASCULITIS; DRUGS; HYPERSENSITIVITY VASCULITIS; PALPABLE PURPURA.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Distribution
  • Aged
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / adverse effects*
  • Anti-Bacterial Agents / pharmacology
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Anti-Inflammatory Agents, Non-Steroidal / pharmacology
  • Biopsy, Needle
  • Cohort Studies
  • Female
  • Humans
  • Immunohistochemistry
  • Incidence
  • Male
  • Middle Aged
  • Prognosis
  • Referral and Consultation
  • Retrospective Studies
  • Severity of Illness Index
  • Sex Distribution
  • Statistics, Nonparametric
  • Tertiary Care Centers
  • Vasculitis / chemically induced*
  • Vasculitis / epidemiology*
  • Vasculitis / pathology
  • Young Adult

Substances

  • Anti-Bacterial Agents
  • Anti-Inflammatory Agents, Non-Steroidal