Cutaneous vasculitis associated with molecular tergeted therapies: systematic review of the literature

Ak, Tümay; Ozince, Rana Berru; Onel, Muhammed

doi:10.1007/s10067-022-06406-6

Cited by 7 publications

(11 citation statements)

References 80 publications

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“…In more severe or refractory cases, topical or systemic corticosteroids are commonly used, concurrent with removal of the inciting medication or treating the underlying infection. Adjunctive therapies previously reported include colchicine and dapsone [12]; NSAIDs have been used anecdotally although may not be preferred in patients with IBD. When an ongoing systemic illness is present, immunosuppression and biologics may be indicated.…”

Section: Discussionmentioning

confidence: 99%

“…Among general immunosuppressants, azathioprine and methotrexate, among others, are described as efficacious [1]. Rituximab has been used in cases associated with systemic vasculitides or malignancies, particularly hematologic [12]. In severe refractory cases of COVID-related vasculitis and cutaneous vasculitis, plasma exchange or intravenous immunoglobulin (IVIG) have also been beneficial [13,14].…”

Section: Discussionmentioning

confidence: 99%

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Lower Extremity Palpable Purpura in a Patient with Quiescent Inflammatory Bowel Disease

et al. 2023

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Lower Extremity Palpable Purpura in a Patient with Quiescent Inflammatory Bowel Disease

et al. 2023

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“…Medications such as penicillins, cephalosporins, sulfonamides, phenytoin, biological agents, particularly the anti-TNF-a molecules [4], and allopurinol may act as haptens and stimulate an immune response triggering the development of vasculitis. Cutaneous small-vessel vasculitis may also develop in the settings of infections such as hepatitis B or C, HIV, infective endocarditis, and infected shuts [5].…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Leukocytoclastic Vasculitis: Diagnostic Approach and Treatment

2023

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Unusual clinical course Background:Leukocytoclastic vasculitis is a small-vessel vasculitis associated with infections, autoimmune disorders, and certain drugs, but it may also be idiopathic. Case Report:We report the case of a 37-year-old woman with no significant past medical history who presented with a chief concern of a full-body rash. Before the rash appeared, she had been treated for group A Streptococcus with amoxicillin and prednisone. An outpatient skin biopsy revealed findings concerning for early leukocytoclastic vasculitis. On admission, she had a diffuse palpable rash on the trunk and upper and lower extremities. Laboratory test results were notable for neutrophilic leukocytosis with a left shift, reticulocytosis with normal hemoglobin, thrombocytosis, and elevated ESR and CRP. An infectious diseases workup was negative, serum levels of complement C3 and C4 were normal, and no evidence of hemolysis was found on blood smear. Results of schistocytes review, LDH, and haptoglobin were not consistent with hemolysis, and IgG, IgA, and IgM were all within normal limits. The patient was initially started on antibiotics due to concern for bullous impetigo, but the treatment regimen was changed to steroids because IgA vasculitis and leukocytoclastic vasculitis were suspected. Biopsy results were received 1 week later and did not reveal definitive findings of acute leukocytoclastic vasculitis. Staining with antibodies to human IgG, IgA, IgM, C3, fibrinogen, and albumin was negative. Conclusions:Leukocytoclastic vasculitis can be triggered by penicillins, cephalosporins, sulfonamides, phenytoin, and allopurinol acting as haptens and stimulating an immune response, resulting in development of vasculitis.

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“…On the other hand, it is also possible that adalimumab, which was used before SEC, might have also contributed to the clinical picture of our patient because anti-TNF agents can cause both IgA nephropathy and LCV. 12,14,21 Still, SEC seems to be the main culprit because of the temporal relationship between SEC initiation and the appearance of the vasculitis. In addition, the fact that our patient has many features in common with other cases in the literature supports the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Secukinumab‐induced IgA vasculitis in a patient with psoriatic arthritis

Ozince

Erzın

et al. 2023

Int J of Rheum Dis

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ObjectivesSecukinumab (SEC) is an effective and widely used drug in psoriatic disease and axial spondyloarthritis. However, SEC has been found to be associated with inflammatory conditions and vasculitis. These inflammatory adverse effects may complicate the treatment of underlying disease, and clinicians may experience difficulties in recognizing and managing this unusual condition.Case ReportA man aged 56 years with psoriatic disease refractory to conventional disease‐modifying antirheumatic drugs was given adalimumab for 6 weeks, then switched to SEC when his psoriatic lesions were exacerbated. After 3 weeks of SEC treatment, he developed systemic features of IgA vasculitis while his skin lesions and arthritis persisted.ConclusionsAlthough SEC‐related inflammatory adverse events, including vasculitis, are rarely encountered in clinical practice, it is essential to recognize them because they can be mistaken as a component of the underlying inflammatory disease. In addition, the dramatic improvement in many cases after the cessation of SEC underlines the importance of making an accurate diagnosis. Pathogenetically, these adverse events are likely to be paradoxical reactions, except for SEC‐induced inflammatory bowel diseases. However, in many aspects, their pathogenesis is controversial and needs clarification.

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Cutaneous vasculitis associated with molecular tergeted therapies: systematic review of the literature

Cited by 7 publications

References 80 publications

Lower Extremity Palpable Purpura in a Patient with Quiescent Inflammatory Bowel Disease

Lower Extremity Palpable Purpura in a Patient with Quiescent Inflammatory Bowel Disease

A Case Report of Leukocytoclastic Vasculitis: Diagnostic Approach and Treatment

Secukinumab‐induced IgA vasculitis in a patient with psoriatic arthritis

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