Current Rheumatology Reports

, Volume 4, Issue 1, pp 55–59

Drug-induced vasculitis

  • Marta Lucia Cuellar


Many therapeutic agents, including recently introduced biologic response modifiers, can induce a variety of vasculitic manifestations ranging from small vessel hypersensitivity vasculitis and leukocytoclastic vasculitis to distinct vasculitic syndromes such as Wegener’s granulomatosis, polyarteritis nodosa, and Churg Strauss syndrome. The pathogenic mechanisms remain to be defined and appear to be multifactorial, with cell-mediated and humural immune mechanisms playing important roles. Clinical presentation varies in severity from mild to severe and even fatal illness, can be self-limiting, or follows a more chronic protracted course. There are no significant differences in clinical presentation, serologic abnormalities, and pathologic findings with the idiopathic forms of vasculitis. However, it is extremely important to identify the offending drug because the discontinuation of the drug is often followed by a rapid improvement of the underlying vasculitic disorder.


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References and Recommended Reading

  1. 1.
    Choi HK, Merkel PA, Walker AM, et al.: Drug-associated antineutrophil cytoplasmic antibody-positive vasculitis: prevalence among patients with high titers of antimyeloperoxidase antibodies. Arthritis Rheum 2000, 43:405–413. Interesting and informative report that suggests that there is an association between high titers MPO-ANCA, vasculitis, and prior use of certain medications, especially PTU and hydralazine.PubMedCrossRefGoogle Scholar
  2. 2.
    Cambridge G, Wallace H, Bernstein RM, et al.: Autoantibodies to myeloperoxidase in idiopathic and drug-induced systemic lupus erythematosus and vasculitis. Br J Rheumatol 1994, 33:109–114.PubMedCrossRefGoogle Scholar
  3. 3.
    Choi HK, Slot MC, Pan G, et al.: Evaluation of antineutrophil cytoplasmic antibody seroconversion induced by minocycline, sulfasalazine, or penicillamine. Arthritis Rheum 2000, 43:2488–2492.PubMedCrossRefGoogle Scholar
  4. 4.
    Sato H, Hattori M, Fujieda M, et al.: High prevalence of antineutrophil cytoplasmic antibody in childhood onset Grave’s disease treated with propylthiouracil. J Clin Endocrinol Metab 2000, 85:4270–4273. More evidence of new onset ANCA positivity in patients treated with PTU. Authors report a high frequency of 64% positivity in 51 children treated for Grave’s disease.PubMedCrossRefGoogle Scholar
  5. 5.
    Sera N, Ashizawa K, Ando T, et al.: Treatment with propylthyouracil is associated with appearance of antineutrophil cytoplasmic antibodies in some patients with Graves disease. Thyroid 2000, 10:595–599. Authors report increased frequency of ANCA in patients treated with PTU but not with methimazol. Association of positive ANCA with constitutional symptoms and agranulocytosis is reported.PubMedCrossRefGoogle Scholar
  6. 6.
    Hiller RM, Savige J, Nassis L, et al.: Antineutrophil cytoplasmic antibody (ANCA)-positive cutaneous leucocytoclastic vasculitis with anti-thyroid therapy in Graves’ disease. Autralas J Dermatol 1998, 39:96–99.Google Scholar
  7. 7.
    Morita S, Veda Y, Eguchi K: Anti-thyroid drug-induced ANCAassociated vasculitis: a case report and review of the literature. Endocrinol J 2000, 47:467–470.Google Scholar
  8. 8.
    Gunton JE, Stiel J, Clifton-Bligh P, et al.: Prevalence of positive anti-neutrophil cytoplasmic antibody (ANCA) in patients receiving anti-thyroid medication. Eur J Endocrinol 2000, 142:587.PubMedCrossRefGoogle Scholar
  9. 9.
    Choi HK, Merkel PA, Tervaert JW, et al.: Alternating antineutrophil cytoplasmic antibody specificity: drug-induced vasculitis in a patient with Wegener’s granulomatosis. Arthritis Rheum 1999, 42:384–388.PubMedCrossRefGoogle Scholar
  10. 10.
    Pillinger M, Staud R: Wegener’s granulomatosis in a patient receiving propylthyiouracil for Graves’ disease. Semin Arthritis Rheum 1998, 28:124–129.PubMedCrossRefGoogle Scholar
  11. 11.
    Eichenfield AH: Minocycline and autoimmunity. Curr Opin Pediatr 1999, 11:447–456. Informative review of minocycline.PubMedCrossRefGoogle Scholar
  12. 12.
    Elkayam O, Yaron M, Caspi D: Minocycline-induced autoimmune syndromes: an overview. Semin Arthritis Rheum 1999, 28:392–397. An extensive review of autoimmune disorders seen with minocycline, including serologic findings.PubMedCrossRefGoogle Scholar
  13. 13.
    Schaffer JV, Davidson DM, McNiff JM, et al.: Perinuclear antineutrophilic cytoplasmic antibody-positive cutaneous polyarteritis nodosa associated with minocycline therapy for acne vulgaris. J Am Acad Dermatol 2001, 44:198–206. Interesting case of cutaneous polyarteritis nodosa associated with minocycline use.PubMedCrossRefGoogle Scholar
  14. 14.
    Schrodt BJ, Kulp-Shorten CL, Callen JP: Necrotizing vasculitis of the skin and uterine cervix associated with minocycline therapy for acne vulgaris. South Med J 1999, 92:502–504. A detailed description with biopsy findings on necrotizing vasculitis induced by minocycline.PubMedCrossRefGoogle Scholar
  15. 15.
    Nesher G, Zuckner J: Rheumatologic complications of vitamin A and retinoids. Semin Arthritis Rheum 1995, 24:291–296.PubMedCrossRefGoogle Scholar
  16. 16.
    Chochrad D, Langhendries JP, Stolear JC, et al.: Isotretinoininduced vasculitis imitating polyarteritis nodosa, with perinuclear antineutrophil cytoplasmic antibody in titers correlated with clinical symptoms. Rev Rhum Engl Ed 1997, 64:129–131.PubMedGoogle Scholar
  17. 17.
    Nicolls MR, Terada LS, Tuder RM, et al.: Diffuse alveolar hemorrhage with underlying pulmonary capillaritis in the retinoic acid syndrome. Am J Resp Crit Care Med 1998, 158:1302–1305.PubMedGoogle Scholar
  18. 18.
    No authors listed: Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 17-1986. An 18-year-old man with cutaneous ulcers and bilateral pulmonary infiltrates. N Engl J Med 1986, 314:1170-1184.Google Scholar
  19. 19.
    Epstein EH Jr, McNutt NS, Beallo R, et al.: Severe vasculitis during isotretinoin therapy. Arch Dermatol 1987, 123:1123–1125.PubMedCrossRefGoogle Scholar
  20. 20.
    Vail T, Descotes J: Clinical toxicity of cytokines used as hemopoyetic growth factors. Drug Safety 1995, 13:371–406.Google Scholar
  21. 21.
    Schliesser G, Pralle H, Lohmeyer J: Leukocytoclastic vasculitis complicating granulocyte colony-stimulating factor (G-CSF) induced neutrophil recovery in T gamma-lymphocytosis with severe neutropenia. Ann Hematol 1992, 65:151–152.PubMedCrossRefGoogle Scholar
  22. 22.
    Jain RR: Cutaneous vasculitis associated with granulocyte colony-stimulating factor. J Am Acad Dermatol 1994, 31:213–215.PubMedGoogle Scholar
  23. 23.
    Vidarsson B, Geirsson AJ, Onundarson PT: Reactivation of rheumatoid arthritis and development of leukocytoclastic vasculitis in a patient receiving granulocyte colony-stimulating factor for Felty’s syndrome. Am J Med 1995, 98:589–591.PubMedCrossRefGoogle Scholar
  24. 24.
    Farhey YD, Herman JH: Vasculitis complicating granulocyte colony stimulating factor treatment of leukopenia and infection in Felty’s syndrome. J Rheumatol 1995, 22:1179–1182.PubMedGoogle Scholar
  25. 25.
    Kelly R, Marsden RA, Bevan D: Exacerbation of psoriasis with GM-CSF therapy [letter]. Br J Dermatol 1993, 128:468–469.PubMedCrossRefGoogle Scholar
  26. 26.
    Dereure O, Bessis D, Lavabre-Bertrand T, et al.: Thrombotic and necrotizing panniculitis associated with recombinant human granulocyte colony-stimulating factor treatment. Br J Dermatol 2000, 142:834–836.PubMedCrossRefGoogle Scholar
  27. 27.
    Couderc LJ, Philippe B, Franck N, et al.: Necrotizing vasculitis and exacerbation of psoriasis after granulocyte colony-stimulating factor for small cell lung carcinoma [letter]. Respir Med 1995, 89:237–238.PubMedCrossRefGoogle Scholar
  28. 28.
    Liozon E, Delaire L, Lacroix P, et al.: Raynaud’s syndrome complicated by digital gangrene during treatment with interpheron alpha. Rev Med Intern 1997, 18:316–319.CrossRefGoogle Scholar
  29. 29.
    Linden D: Severe Raynaud’s phenomenon associated with interferon beta treatment for multiple sclerosis. Lancet 1998, 352:878–879.PubMedCrossRefGoogle Scholar
  30. 30.
    Creutzig A, Freund M, Caspary L, et al.: Microangiopathy in patients with chronic myelogenous leukemia treated with interferon. Microvasc Res 1996, 52:288–292.PubMedCrossRefGoogle Scholar
  31. 31.
    No authors listed. Case records of the Massachusetts General Hospital. Case 30-2000. A 25-year-old man with asthma, cardiac failure, diarrhea, and weakness of the right hand. N Engl J Med 2000, 343:953-961.Google Scholar
  32. 32.
    Gruer P, Bold T, Vilardo L: Case 30-2000: Churg-Strauss syndrome [letter]. N Engl J Med 2001, 344:858–859.PubMedCrossRefGoogle Scholar
  33. 33.
    Dietz A, Hubner C, Andrassy K: Macrolide antibiotic-induced vasculitis (CSS). Laryngorhinootologic 1998, 77:111–114.Google Scholar
  34. 34.
    Le Gall C, Pham S, Vignes S, et al.: Inhaled corticosteroids and Churg Strauss syndrome. Eur Resp J 2000, 15:978–981. Five cases of CSS are reported. All are asthmatic patients in whom systemic steroids were discontinued after steroid inhalers were given.CrossRefGoogle Scholar
  35. 35.
    Kernan WN, Viscoli CM, Brass LM, et al.: Phenylpropanolamine and the risk of hemorrhagic stroke. N Engl J Med 2000, 343:1826–1832.PubMedCrossRefGoogle Scholar
  36. 36.
    Ozawa T, Sasqki O, Socimachi T, et al.: Primary angiitis of the central nervous system: report of two cases and review of the literature. Neurosurgery 1995, 36:173–179.PubMedCrossRefGoogle Scholar
  37. 37.
    Clifford-Jones RE, Love SS, Gurusinghe N: Granulomatous angiitis of the central nervous system: a case with recurrent intracerebral hemorrhage. J Neurol Neurosurg Psychiatry 1985, 48:1054–1056.PubMedCrossRefGoogle Scholar
  38. 38.
    Forman HP, Levin S, Stewart B, et al.: Cerebral vasculitis and hemorrhage in an adolescent taking diet pills containing phenylpropanolamine: case report and review of literature. Pediatrics 1989, 83:737–741.PubMedGoogle Scholar

Copyright information

© Current Science Inc 2002

Authors and Affiliations

  • Marta Lucia Cuellar
    • 1
  1. 1.Section of Allergy, Immunology and Rheumatology, Department of MedicineTulane University Medical CenterNew OrleansUSA

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