Zoledronate induced urticarial vasculitis

Abstract

A 71-years-old woman, a known case of osteoporosis, T12 vertebral collapse, pulmonary Koch's, hypertension, hyperuricemia, and diabetes presented to the emergency department with reddish itchy lesions over face, trunk, bilateral upper limbs, and lower limbs for the past 3 days.These lesions started from the trunk followed by involvement of extremities, and face within few hours. Lesions appeared 1 day after taking zoledronate intravenous injection for osteoporosis. There was no history of swelling of lips, eyelids, breathlessness, and pain in the abdomen. There was no history of fever, joint pain, cola-colored urine, difficulty in getting up from squatting position, combing hair, and myalgia.Treatment history includes telmisartan, febuxostat, metformin for the past 7-8 years, and antitubercular (first line) drugs for the past 1 month. For cutaneous lesions, the patient had taken antihistamines for 3 days with minimal relief.On examination, there were multiple erythematous, edematous papules and plaques with few lesions showing purpura, nonscaly, partially blanchable to nonblanchable, nontender, varying in size from 0.5 Â 0.5 cm to 6 Â 6 cm over face, trunk (Figure S1), buttocks (Figure 1A), bilateral upper and lower limbs (Figure S2), palms, and soles.

Zoledronate-Induced Large Vessel Vasculitis Diagnosed by PET/CT

“…Both previously reported cases of GCA had ophthalmic manifestation [2,3]. In the literature, there are also single reports of orbital vasculitis secondary to zoledronate without defining GCA, but these cases might be consistent with this diagnosis as well [17,18].…”