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Cutaneous vasculitis associated with fluoroquinolones

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Abstract

Cutaneous vasculitis is a clinical entity with a broad differential diagnosis, including an adverse drug reaction. It is defined as inflammation of skin blood vessel walls. During a 7-year-period, we observed three patients who developed isolated cutaneous vasculitis during antibiotic therapy of bacterial infection. All were treated with a fluoroquinolone (ciprofloxacin or levofloxacin) combined with rifampin (two cases) or flucloxacillin (three cases), respectively. In all three cases the lesions gradually resolved after treatment with the inciting fluoroquinolone had been stopped. In one patient, leukocytoclastic small-vessel vasculitis was histologically confirmed. Fluoroquinolone-associated cutaneous vasculitis consists of an isolated self-limiting disorder that is part of a systemic vasculitis, or even life-threatening disease. Clinicians should be aware of this serious adverse event because any continuation of treatment may be fatal.

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References

  1. Jennette JC, Falk RJ: Small-vessel vasculitis. N Engl J Med 1997; 337: 1512–1523.

    Article  CAS  PubMed  Google Scholar 

  2. Roujeau JC, Stern RS: Severe adverse cutaneous reactions to drugs. N Engl J Med 1994; 331: 1272–1285.

    Article  CAS  PubMed  Google Scholar 

  3. Crowson AN, Mihm MC Jr, Magro CM: Cutaneous vasculitis: a review. J Cutan Pathol 2003; 30: 161–173.

    Article  PubMed  Google Scholar 

  4. Savage CO, Harper L, Cockwell P, Adu D, Howie AJ: ABC of arterial and vascular disease: vasculitis. Br Med J 2000; 320: 1325–1328.

    Article  CAS  Google Scholar 

  5. Jennette JC, Falk RJ, Andrassy K, Bacon PA, Churg J, Gross WL, Hagen EC, Hoffman GS, Hunder GG, Kallenberg CG, et al. Nomenclature of systemic vasculitides. Proposal of an international consensus conference. Arthritis Rheum 1994; 37: 187–192.

    Article  CAS  PubMed  Google Scholar 

  6. Lantin JP, Gattesco S, Duclos A, Zanchi A, Schaller MD, Pecoud A, Aubert V: Anaphylactoid purpura like vasculitis following fibrinolytic therapy: role of the immune response to streptokinase. Clin Exp Rheumatol 1994; 12: 429–433.

    CAS  PubMed  Google Scholar 

  7. Stokes MB, Foster K, Markowitz GS, Ebrahimi F, Hines W, Kaufman D, Moore B, Wolde D, D’Agati VD: Development of glomerulonephritis during anti-TNF-alpha therapy for rheumatoid arthritis. Nephrol Dial Transplant 2005; 20: 1400–1406.

    Article  CAS  PubMed  Google Scholar 

  8. Calabrese LH, Duna GF: Drug-induced vasculitis. Curr Opin Rheumatol 1996; 8: 34–40.

    Article  CAS  PubMed  Google Scholar 

  9. Mullick FG, McAllister HA Jr, Wagner BM, Fenoglio JJ Jr: Drug related vasculitis. Clinicopathologic correlations in 30 patients. Hum Pathol 1979; 10: 313–325.

    Article  CAS  PubMed  Google Scholar 

  10. Michel BA, Hunder GG, Bloch DA, Calabrese LH: Hypersensitivity vasculitis and Henoch-Schonlein purpura: a comparison between the 2 disorders. J Rheumatol 1992; 19: 721–728.

    CAS  PubMed  Google Scholar 

  11. Beuselinck B, Devuyst O: Ciprofloxacin-induced hypersensitivity vasculitis. Acta Clin Belg 1994; 49: 173–176.

    CAS  PubMed  Google Scholar 

  12. Famularo G, De Simone C: Nephrotoxicity and purpura associated with levofloxacin. Ann Pharmacother 2002; 36: 1380–1382.

    Article  PubMed  Google Scholar 

  13. Huminer D, Cohen JD, Majadla R, Dux S: Hypersensitivity vasculitis due to ofloxacin. Br Med J 1989; 299: 303.

    Article  CAS  Google Scholar 

  14. Lieu PK, Tok SC, Ismail NH, Chng HH: Ciprofloxacin-induced cutaneous vasculitis. Allergy 1997; 52: 593–594.

    Article  CAS  PubMed  Google Scholar 

  15. Pace JL, Gatt P: Fatal vasculitis associated with ofloxacin. Br Med J 1989; 299: 658.

    Article  CAS  Google Scholar 

  16. Pipek R, Vulfsons S, Wolfovitz E, Har-Shai Y, Taran A, Peled IJ: Case report: ofloxacin-induced hypersensitivity vasculitis. Am J Med Sci 1996; 311: 82–83.

    Article  CAS  PubMed  Google Scholar 

  17. Pons R, Escutia B: Ciprofloxacin-induced vasculitis with cutaneous and renal involvement. Nefrologia 2001; 21: 209–212.

    CAS  PubMed  Google Scholar 

  18. Shih DJ, Korbet SM, Rydel JJ, Schwartz MM: Renal vasculitis associated with ciprofloxacin. Am J Kidney Dis 1995; 26: 516–519.

    Article  CAS  PubMed  Google Scholar 

  19. Stubbings J, Sheehan-Dare R, Shernaz W: Cutaneous vasculitis due to ciprofloxacin. Br Med J 1992; 305: 29.

    Article  CAS  Google Scholar 

  20. Zaigraykin N, Kovalev J, Elias N, Naschitz JE: Levofloxacin-induced interstitial nephritis and vasculitis in an elderly woman. Isr Med Assoc J 2006; 8: 726–727.

    PubMed  Google Scholar 

Download references

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Correspondence to W. Zimmerli.

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Maunz, G., Conzett, T. & Zimmerli, W. Cutaneous vasculitis associated with fluoroquinolones. Infection 37, 466–468 (2009). https://doi.org/10.1007/s15010-009-8437-4

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  • DOI: https://doi.org/10.1007/s15010-009-8437-4

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