Rare adverse effect of a common drug: nitrofurantoin-induced ANCA-associated vasculitis

Agarwal, Abhishek; Nathan, Karim; Roy, Satyajeet

doi:10.1136/bcr-2014-209253

Cited by 15 publications

(6 citation statements)

References 9 publications

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“…2 Although these are the most common medications associated with AAV, there have been many other case reports linking many additional classes of medications to drug-associated AAV. [6][7][8][9][10][11][12][13][14][15][16][17][18] As mentioned, most of the data about drug-associated AAV come from anti-thyroid drug (ATD)-associated AAV (ATD-AAV). However, the clinical manifestations and severity of drug-associated AAV vary from drug to drug.…”

Section: Discussionmentioning

confidence: 99%

Late Onset of Rivaroxaban-Associated Anti-Neutrophil Cytoplasmic Antibody–Associated Vasculitis

Agarwal,

Cummings,

Larsen

et al. 2023

Journal of Investigative Medicine High Impact Case Reports

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Although anti-thyroid drugs (ATDs) are the most common cause of drug-associated anti-neutrophil cytoplasmic antibody (ANCA) vasculitis (AAV), many other classes of drugs can lead to drug-associated AAV. We present a unique case of rivaroxaban-associated AAV. A 76-year-old female with a past medical history of atrial fibrillation on rivaroxaban presented with fatigue, bilateral lower extremity purpura, and hemoptysis to an outside hospital. Investigations revealed a positive cytoplasmic-ANCA (c-ANCA) titer of 1:320 and a positive anti-myeloperoxidase (anti-MPO), and negative perinuclear-ANCA (p-ANCA) and anti-proteinase 3 (anti-PR3). In addition, chest imaging demonstrated bilateral ground-glass opacities which raised suspicion for diffuse alveolar hemorrhage (DAH). A lung biopsy revealed acute and ongoing DAH with focally active capillaritis and characteristic pathological findings, which strongly suggested that was likely secondary to rivaroxaban. Rivaroxaban was discontinued, and the patient received pulses of intravenous glucocorticosteroids and rituximab. Her symptoms improved. She continued immunosuppressive therapy with rituximab for 2 years. She presented to our hospital for a second opinion regarding the discontinuation of rituximab, and we decided to discontinue rituximab. After discontinuation, the patient remained stable after 1.5 years of follow-up and did not have any relapses. This is a unique case of rivaroxaban-associated AAV. Clinicians should consider drug-associated AAV in all patients who present with an atypical clinical presentation and/or pathological findings of AAV. Given the broad and rapidly increasing use of novel anticoagulants, it is important to raise awareness of this potential complication. Prompt discontinuation of the drug and initiation of immunosuppressant treatment in severe cases may be lifesaving.

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Section: Discussionmentioning

confidence: 99%

Late Onset of Rivaroxaban-Associated Anti-Neutrophil Cytoplasmic Antibody–Associated Vasculitis

Agarwal,

Cummings,

Larsen

et al. 2023

Journal of Investigative Medicine High Impact Case Reports

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“…[15][16][17] In addition, there have been 2 reported cases of systemic vasculitis with skin and renal involvement and no peripheral nerve involvement, associated with positive p-ANCA and MPO antibodies. 18,19 Both patients (a 67-year-old female and a 45-year-old male) were treated for a UTI and developed symptoms 3-4 days later, with resolution of the symptoms after treatment with oral prednisone and stopping nitrofurantoin. No biopsy was performed in the second case.…”

Section: Discussionmentioning

confidence: 99%

Nitrofurantoin and Minocycline–Associated Vasculitic Neuropathy: Case Reports and Literature Review

Aladawi

Shelly

Dyck

et al. 2022

Journal of Clinical Neuromuscular Disease

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Background:Vasculitic neuropathies usually present acutely to subacutely, with an asymmetric pattern, involving multiple peripheral nerve territories. Drug-induced vasculitis is an often overlooked etiology of vasculitic neuropathy. Methods:We present the first reported case of nitrofurantoinassociated and an illustrative case of minocyclineassociated vasculitic neuropathy, with a review of the literature. Results:The first patient is a 60-year-old woman who developed axonal sensorimotor peripheral neuropathy after nitrofurantoin use, with a superficial radial nerve biopsy confirming vasculitis. The second patient is a 23-year-old woman, with a history of acne vulgaris treated with minocycline, who presented with a subacute right common peroneal mononeuropathy followed by a left deep peroneal mononeuropathy, with elevated antinuclear, perinuclear-antineutrophil cytoplasmic, and myleoperoxidase antibodies, and MPO titers, and a sural nerve biopsy showing large arteriole vasculitis. Finally, we provide a comprehensive review of previously published cases. Conclusions:Medications should be considered as a trigger for medication-induced vasculitic neuropathy. Accurate diagnosis would ensure timely treatment.

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“…Nitrofurantoin is an antibiotic commonly used to treat urinary tract infections and was identified as the major compound in many worldwide drug residue violations ( 32 ). Nitrofurantoin has been reported to induce immune-mediated lung and liver disease ( 33 ), sub-acute cutaneous lupus erythematosus ( 34 ), and antineutrophilcytoplasmic antibodies (ANCA)-associated vasculitis ( 35 ) in some rare cases. Nitrofurantoin can induce both humoral and cellular immune responses, increasing the T helper/T-suppressor lymphocytes ratio, and stimulating the production of autoantibodies ( 36 , 37 ).…”

Section: Discussionmentioning

confidence: 99%

Identification of Novel Environmental Substances Relevant to Pediatric Graves’ Disease

Qin

Liu

et al. 2021

Front. Endocrinol.

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Graves’ disease (GD) is the most common cause of hyperthyroidism, yet a relatively rare disease in the pediatric population. GD is a complex disorder influenced by both genetic and environmental factors. In this study, we aimed to find new environmental factors influencing the pathogenesis of GD. We investigated serum substances in 30 newly diagnosed GD children and 30 age- and gender-matched healthy controls. We measured total iodine by inductively coupled plasma-mass spectrometry (ICP-MS), analyzed perfluorinated compounds via ultra-high-performance liquid chromatography coupled with multiple reaction monitoring mass spectrometry (UHPLC-MRM-MS), and explored other environmental substances using ultra-high-performance liquid chromatography–quadrupole time-of-flight mass spectrometry (UHPLC–QTOF/MS) analysis. Twenty-nine single-nucleotide polymorphisms (SNPs) in eight genes related to GD were analyzed by SNaPshot. The serum total iodine was significantly higher in GD group, but its association with GD onset was weak, only with Exp(B) value near 1. The perfluorinated compound levels were not different between the two groups. More importantly, we found 16 environmental substances significantly different between GD and control groups, among which ponasterone A is a risk factor (p = 0.007 and Exp(B) = 14.14), while confertifoline is a protective factor against GD onset (p = 0.002 and Exp(B) = 0.001). We also identified 10 substances correlated significantly with thyroid indices in GD patients, among which seven associated with levels of the thyroid autoantibody TPOAb. No known SNPs were found predisposing GD. In this study, we explored a broad variety of environmental substances and identified novel factors that are potentially involved in the pediatric GD pathogenesis.

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Rare adverse effect of a common drug: nitrofurantoin-induced ANCA-associated vasculitis

Cited by 15 publications

References 9 publications

Late Onset of Rivaroxaban-Associated Anti-Neutrophil Cytoplasmic Antibody–Associated Vasculitis

Late Onset of Rivaroxaban-Associated Anti-Neutrophil Cytoplasmic Antibody–Associated Vasculitis

Nitrofurantoin and Minocycline–Associated Vasculitic Neuropathy: Case Reports and Literature Review

Identification of Novel Environmental Substances Relevant to Pediatric Graves’ Disease

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