Francisco Ortiz-Sanjuán1, Ricardo Blanco1, José L Hernández1, Trinitario Pina1, María C González-Vela1, Héctor Fernández-Llaca1, Vanesa Calvo-Río1, Javier Loricera1, Susana Armesto1, Marcos A González-López1, Javier Rueda-Gotor1, Miguel A González-Gay2. 1. From the Divisions of Rheumatology, Internal Medicine, Pathology, and Dermatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.F. Ortiz-Sanjuán, MD; R. Blanco, MD, PhD; T. Pina, MD; V. Calvo-Río, MD; J. Loricera, MD; J. Rueda-Gotor, MD; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, University of Cantabria; J.L. Hernández, MD, PhD, División of Internal Medicine, Hospital Universitario Marqués de Valdecilla, University of Cantabria; M.C. González-Vela, MD, PhD, Division of Pathology, Hospital Universitario Marqués de Valdecilla; H. Fernández-Llaca, MD; S. Armesto, MD, PhD; M.A. González-López, MD, PhD, División of Dermatology, Hospital Universitario Marqués de Valdecilla. 2. From the Divisions of Rheumatology, Internal Medicine, Pathology, and Dermatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.F. Ortiz-Sanjuán, MD; R. Blanco, MD, PhD; T. Pina, MD; V. Calvo-Río, MD; J. Loricera, MD; J. Rueda-Gotor, MD; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, University of Cantabria; J.L. Hernández, MD, PhD, División of Internal Medicine, Hospital Universitario Marqués de Valdecilla, University of Cantabria; M.C. González-Vela, MD, PhD, Division of Pathology, Hospital Universitario Marqués de Valdecilla; H. Fernández-Llaca, MD; S. Armesto, MD, PhD; M.A. González-López, MD, PhD, División of Dermatology, Hospital Universitario Marqués de Valdecilla. miguelaggay@hotmail.com.
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.
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.
Authors: Thâmara Cristiane Alves Batista Morita; Gabriela Franco S Trés; Roberta Fachini Jardim Criado; Mirian Nacagami Sotto; Paulo Ricardo Criado Journal: An Bras Dermatol Date: 2020-03-26 Impact factor: 1.896
Authors: Isabel Zdora; Jonathan Raue; Franz Söbbeler; Andrea Tipold; Wolfgang Baumgärtner; Jasmin Nicole Nessler Journal: Front Vet Sci Date: 2022-08-24