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Hematoxylin and eosin stained skin biopsy showing epidermis and dermis with periadnexal and interstitial inflammatory cell infiltrate (red arrows), magnification = 5 ×.
Source publication
Tenofovir, a nucleotide analog, is one of the first-line medications recommended for the treatment of active chronic hepatitis B virus infection (CHB) and as a primary prophylaxis to prevent hepatitis B reactivation in cases of immunosuppression. We report the first case of tenofovir-induced leukocytoclastic vasculitis (LCV). A 43-year-old obese wo...
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Background and aim
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Citations
... The etiology of it is unknown in nearly half of the cases but it can be triggered by viral, bacterial infections, autoimmune rheumatological conditions, medications, and even malignancies [ Table 3]. 3,10 ...
... Causes of Small Vessels Vasculitis.10,11 Inflammatory bowel disease, Behçet disease Hypergammaglobulinemic purpura of Waldenström, Seronegative spondyloarthropathies Sarcoidosis, Cystic fibrosis, Primary biliary cirrhosis, Bowel-associated dermatosisarthritis syndrome, Gluten enteropathy Quinidine Other Allopurinol, Bortezomib penicillamine, G-CSF, NSAIDs Propylthiouracil Streptokinase Antimicrobials Quinine, Vancomycin Cardiovascular ACE inhibitors, Betablockers Furosemide, Other Cocaine, adulterated with levamisole, COX-2 inhibitors, Interferons Leukotriene inhibitors, Methotrexate, Oral contraceptives ,Phenytoin ,Retinoids , Sulfonylureas ,TNF-α inhibitors ,Warfarin Antimicrobials Mefloquine, Cardiovascular Amiodarone, Neuropsychiatric Atypical antipsychotics, Gabapentin, Phenothiazine SSRIs, Other Insulin, Metformin Methamphetamine, Rituximab, Miscellaneous Radiographic contrast media Food/drug additives, Vitamins Solid organ carcinomas (IgA vasculitis in adults ≫ other forms of CSVV) ...
... [4] Diagnosis of LCV is confirmed by histopathological evaluation of the biopsy from the lesion with support of additional laboratory tests performed for systemic involvement and its etiology. [5] Drugs are responsible for about 10% of LCV cases, and most common drugs associated with vasculitis are propylthioruacil, hydralazine, minocycline, allopurinol, D-penicillamine, sulfasalazine, penicillin, cephalosporins, and several immunomodulating agents. [6] Hypersensitivity or drug-induced vasculitis is defined by the following five criteria proposed by the American College of Rheumatology: (1) age >16 at disease onset, (2) history of taking a medication at onset that may have been a precipitating factor, (3) the presence of palpable purpura, (4) the presence of maculopapular rash, and (5) a biopsy demonstrating granulocytes around an arteriole or a venule (LCV). ...
... Nearly one-half patients required immunosuppressive therapy in addition to drug cessation. [4] Anecdotal reports of CLCV exist with commonly used drugs such as metformin, [5] glyburide, [6] telmisartan, [7] tenofovir, [8] clopidogrel, [9] and clomiphene. [10] Commonly used antitubercular drugs such as isoniazid and rifampicin have also been reported to cause CLCV. ...
Vascular injury due to drugs is recognized as a distinct entity under the Chapel Hill Consensus Conference 2012 definitions for vasculitis. Drug-induced vasculitis (DIV) may affect various types of vessels. Isolated cutaneous leukocytoclastic vasculitis is most commonly seen in association with antibiotics and nonsteroidal anti-inflammatory drugs. Drug-induced antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis has been classically associated with cocaine (alone or contaminated with levamisole), antithyroid drugs (propylthiouracil, methimazole, carbimazole) and hydralazine; minocycline often mimics medium-vessel vasculitis, with ANCA positivity. Drug-induced large-vessel vasculitis remains rare; however, it has been reported with anticancer agents targeting immune pathways, including immune checkpoint inhibitors. Cerebral vasculitis has been associated with oral or topical sympathomimetic drug use. Operational pathogenetic mechanisms in DIV include immune complex deposition, abnormal generation of neutrophil extracellular traps, and bypassing of normal immune checkpoints like that between programmed cell death ligand 1 on dendritic cells and programmed cell death 1 on T-lymphocytes. DIV can have an unpredictable course, and a significant proportion of patients require immunosuppressive therapy in addition to drug withdrawal.
... Drugs might play a role in the etiology of LCV. [7] Our patient had no history suggestive of connective tissue disorder or viral prodrome. Because amlodipine was the only recent drug to which he was exposed to, it was thought to be the etiological trigger. ...
A hypertensive elderly male on amlodipine presented with a palpable purpuric rash on both legs followed by shoulder, buttocks, and back with foot ulcer, which was found to be leukocytoclastic vasculitis on skin biopsy. The patient recovered completely on discontinuation of amlodipine and short-term steroid.
