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drug-related vasculitis
Etiology:
1) antimicrobial agents
a) minocycline
b) sulfonamides
c) penicillins
2) vaccines
3) antithyroid agents:
- propylthiouracil (80-90%)
- less frequently methimazole, carbimazole, benzylthiouracil
4) anticonvulsants: phenytoin
5) antiarrhythmic agents & other cardiovascular drugs
- diuretics, hydralzine
6) anticoagulants
7) antineoplastic agents
8) diuretics: thiazides
9) hematopoietic growth factors
10) NSAIDs
11) leukotriene inhibitors
12) psychotropic drugs
13) sympathomimetics
14) allopurinol
15) TNF-alpha inhibitors
16) interferon alfa
17) levamisole (associated with cocaine)
18) gold*
* not listed in [2]
Clinical manifestations:
1) predominantly cutaneous manifestations
a) palpable purpura most common form
1] generalized
2] limited to lower extremities & other dependent areas
b) urticaria, ulceration & hemorrhagic blisters less common
2) systemic manifestations may occur
a) fever
b) malaise
c) polyarthralgias
Laboratory:
1) mild leukocytosis with or without eosinophilia
2) elevated erythrocyte sedimentation rate (ESR)
General
secondary vasculitis
References
- Harrison's Principles of Internal Medicine, 14th ed.
Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 1919
- Medical Knowledge Self Assessment Program (MKSAP) 16, 18
American College of Physicians, Philadelphia 2012, 2018.