Brumfield, Elisha

Hauser, Rachael

Biodiversity Informatics

Palpable Purpura with Hemorrhagic Bullae Hydrochlorothiazide Induced Vasculitis Rachael Hauser M.D.;  Elisha Brumfield D.O.     Case Presentation • History: 34 year-old previously healthy Hispanic female was transferred from an outlying hospital for concerns of progressive rash of two weeks duration with lower extremity edema, severe pruritus, arthralgia, abdominal pain • Past medical history: newly diagnosed with hypertension, treated with Hydrochlorothiazide for one month • Laboratory: UA, CBC, ANCA, ESR, Complement, RAF, ANA Panel, Cryoglobulin,       HIV, Hepatitis studies were normal • Cutaneous Biopsy: Inflammatory infiltration of lymphocytes and neutrophils, extravasation of erythrocytes, fibrin deposition in the walls of the small blood vessels with no evidence of IgA antibodies by direct immunofluorescence • Treatment: discontinued Hydrochlorothiazide,         began high dose IV steroid therapy with       transition to oral taper  • Follow up: patient revealed prolonged recovery with continued hyperpigmented lesions and peripheral neuropathy           Discussion   • Hypersensitivity vasculitis is a clinical syndrome due to immune complex deposition in capillaries, venules, and arterioles1 • Clinical symptoms are most commonly palpable purpura, but also includes arthralgia, myalgia, fever • Latent period typically 7-10 days after exposure to offending agent • Diagnostic Criteria2 o Age > 16 o Offending agent  o Palpable purpura o Maculopapular rash o Biopsy with neutrophils around arterioles/venules • Common insulting medications include penicillin, cephalosporins, loop diuretics, and thiazide diuretics • These agents function as a hapten to stimulate an immune response3 • Infections such as hepatitis and HIV have also been associated • Although an infrequent adverse reaction to a regularly prescribed medication, providers   must be aware of this risk to provide  appropriate treatment and prevent   long term sequelae        Introduction     References   1. Tosca N, Stratigos JD. Possible pathogenetic mechanisms in allergic cutaneous vasculitis.  Int J Dermatol 1988;27(5):291-6. 2. Calabrese LH, Michel BA, Bloch DA, et al.  The American College of Rheumatology 1990 criteria for the classification of hypersensitivity vasculitis.  Arthritis Rheum 1990;33(8):1108-13. 3. Calabrese LH, Duna GF.  Drug-induced vasculitis.  Curr Opin Rheumatol 1996;8(1):34-40. • Cutaneous leukocytoclastic angiitis, or hypersensitivity vasculitis, can result from treatment by many commonly prescribed medications  • Patients present with various manifestations, which may delay diagnosis and appropriate treatment Punch Biopsy:   Extravasation of lymphocytes and erythrocytes. 

Hydrochlorothiazide Induced Vasculitis

The University of Kansas: Journals@KU

English

https://journals.ku.edu/kjm/article/download/11368/10775

Hydrochlorothiazide Induced Vasculitis

Abstract

Similar works

Full text

Available Versions

Biodiversity Informatics

The University of Kansas: Journals@KU