Drug-associated Cutaneous Vasculitis: Study of 239 Patients from a Single Referral Center

Sanjuán, Francisco Miguel Ortíz; Blanco, Ricardo; Hernández, José L.; Pina, Trinitario; González‐Vela, M. Carmen; Fernández‐Llaca, Héctor; Calvo-Río, V.; Loricera, J.; Armesto, Susana; González‐López, Marcos A.; Rueda-Gotor, Javier

doi:10.3899/jrheum.140390

Cited by 33 publications

(29 citation statements)

References 42 publications

(50 reference statements)

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“…The latter were preferentially deposited in the vessels of the inflamed gingiva, causing both ischemic lesions due to necrosis, as well as hemorrhage manifesting with petechiae. It should be noted that in our case alirocumab treatment was discontinued as the patient experienced adverse events from the GI tract and the joints, findings consistent with vasculitis …”

Section: Discussionmentioning

confidence: 58%

“…Monoclonal antibodies used as therapeutic agents are increasingly implicated in vasculitis and vasculitis is a known side effect of alirocumab, although its incidence is not known . Drug‐associated vasculitis may range from a localized cutaneous vasculitis to a severe life‐threatening syndrome with multiple organ involvement . Cutaneous vasculitis has no diagnostic clinical, laboratory, or pathologic finding .…”

Section: Discussionmentioning

confidence: 99%

“…Withdrawal of the offending agent is usually curative. An immunocomplex deposition/type III hypersensitivity reaction is considered as the most probable pathogenetic mechanism . Anti‐alirocumab antibodies were observed in 155 of 3,039 patients (5.1%) medicated with the drug .…”

Section: Discussionmentioning

confidence: 99%

“…Vasculitis is a common drug-related adverse effect, characterized by vessel inflammation and necrosis. 13 Monoclonal antibodies used as therapeutic agents are increasingly implicated in vasculitis 14 and vasculitis is a known side effect of alirocumab, although its incidence is not known. 1 Drug-associated vasculitis may range from a localized cutaneous vasculitis to a severe life-threatening syndrome with multiple organ involvement.…”

Section: Discussionmentioning

confidence: 99%

“…13,14 Cutaneous vasculitis has no diagnostic clinical, laboratory, or pathologic finding. 13 It usually manifests with hemorrhagic lesions, in particular palpable porphyra that may be accompanied by gastrointestinal (GI), joint, and kidney involvement. Withdrawal of the offending agent is usually curative.…”

Section: Discussionmentioning

confidence: 99%

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Gingival Ischemia and Petechiae in a Patient Medicated With PCSK9 Inhibitor for Hypercholesterolemia: An Adverse Drug Event?

Thermos

Tosios

2018

Clin Adv Periodontics

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Introduction Monoclonal antibodies against proprotein‐convertase subtilisin/kexin type 9 (PCSK9) inhibitors are a newly‐introduced therapeutic approach against hypercholesterolemia. Clinical trials have reported few adverse effects of PCSK9 inhibitors and there are no reports of oral adverse effects. We present the case of a patient that showed gingival discomfort on eating and toothbrushing, coupled with the presence of gingival ischemia and petechiae, 3 days after a subcutaneous abdominal injection of 75‐mg alirocumab for hypercholesterolemia, and contemplate on their possible pathogenesis. Case Presentation Αn 81‐year‐old male presented with gingival discomfort during eating and toothbrushing, 3 days after receiving a subcutaneous abdominal injection of alirocumab. Intraoral examination revealed that the anterior free and attached gingiva of both jaws appeared pale and the surrounding mucosa showed confluent petechiae that were more evident on the anterior palatal gingiva. The patient was asked to brush his teeth with a soft toothbrush and use a mouthwash containing hydrogen peroxide three times daily. At the 8‐day re‐examination he was symptom‐free, and the mucosa appeared totally normal. At the 5‐month follow‐up visit he reported having the same symptoms after each one of the 12 doses of alirocumab he received. Conclusions Adverse dugs effects associated with subcutaneous injection of alirocumab may manifest in the gingiva. Therefore, oral and periodontal examination should be included in the regular follow‐up of patients medicated with this drug.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Gingival Ischemia and Petechiae in a Patient Medicated With PCSK9 Inhibitor for Hypercholesterolemia: An Adverse Drug Event?

Thermos

Tosios

2018

Clin Adv Periodontics

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Cutaneous small‐vessel vasculitis following hysterosalpingo‐foam sonography (HyFoSy)

Ludwin

Szczeklik

et al. 2019

Ultrasound in Obstet & Gyne

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We present a case of diffuse skin immune reaction, diagnosed as cutaneous small‐vessel vasculitis, following assessment of tubal patency by contrast ultrasound, which appears to be the first reported case of hypersensitivity reaction to sonographic tubal patency testing, based on a literature search. A 32‐year‐old woman presented with non‐thrombocytopenic palpable purpura the day after assessment of tubal patency by two‐/three‐dimensional hysterosalpingo‐foam sonography (HyFoSy) using ExEm® Foam. During real‐time ultrasound, the observer identified flow in only the right tube when using saline with air as contrast medium; however, the same observer identified flow in both tubes after injecting ExEm Foam and the woman left the clinic without any complications. The next day, the patient was admitted with a complaint of a red‐purple skin rash noticed the same morning, associated with moderate leg pain. Slow‐motion analysis of the recorded videos and three‐dimensional ultrasound datasets showed previously unnoticed venous intravasation of ExEm Foam into the myometrial vessels. Palpable purpura is typically found in vasculitis as a result of extravasation of red cells outside the inflamed blood vessel. This previously unreported side effect of tubal patency testing by HyFoSy, its potential rare organ consequences, as well as unknown consequences of venous intravasation by foam, should be included in the informed consent prior to the examination. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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Drug-Induced Vasculitis

Stack

2022

Drug Eruptions

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Drug-associated Cutaneous Vasculitis: Study of 239 Patients from a Single Referral Center

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

Cited by 33 publications

References 42 publications

Gingival Ischemia and Petechiae in a Patient Medicated With PCSK9 Inhibitor for Hypercholesterolemia: An Adverse Drug Event?

Gingival Ischemia and Petechiae in a Patient Medicated With PCSK9 Inhibitor for Hypercholesterolemia: An Adverse Drug Event?

Cutaneous small‐vessel vasculitis following hysterosalpingo‐foam sonography (HyFoSy)

Drug-Induced Vasculitis

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