Background/Purpose

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 of patients with DACV attending to a tertiary referral hospital over a 36-year period were reviewed. A diagnosis of DACV was considered if the drug was taken within a week before the onset of the disease.

Results

239 (30.9%) patients (133 men and 106 women with a mean age of 36 years) from a series of 773 unselected cutaneous vasculitis were diagnosed with DACV. Antibiotics (n=149; 62.3%) -mainly β-lactams-, and non-steroidal-anti-inflammatory drugs (NSAIDs) (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 follow-up of 5 months, relapses occurred in 18.4% of patients, and persistent microhematuria or renal insufficiency in 3.3% and 2.9%, respectively.

Conclusion

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

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/drug-associated-cutaneous-vasculitis-study-of-239-patients-from-a-single-referral-center/