[Hypersensitive urticarial vasculitis after natisedine intake].
BACKGROUND
Various skin and mucosal reactions can be observed after administration of quinidine derivatives.


METHODS
A patient who was taking Natisédine (quinidine phenylethyl barbiturate) intermittently and at reintroduction developed a papulopurpuric eruption (without thrombopenia) producing extensive centrifugal annular infiltration and central healing which regressed approximately one week after drug withdrawal. This eruption was associated with moderate 24 h proteinuria. The clinical aspect was that of vasculitis purpura as confirmed histology. Direct immunofluorescence only demonstrated C3 deposits in the vessel walls of the superficial dermis. The quinidine moiety of this drug (currently removed from the formulation) appears to be the responsible agent (imputability score: 13 B3).


CONCLUSIONS
Thrombopenic purpura by synthesis of anti-platelet antibodies induced by quinidine derivatives is well known. Inversely, cases of non-thrombopenic purpura imputable to these same derivatives is uncommon (7 reported cases). The pathophysiological mechanisms involved might be similar (antigenic similarity between the platelet surface and endothelium).
Loche
F
F
Service de Dermatologie, C.H.U. Purpan, Toulouse.
Laplanche
G
G
Bazex
J
J
D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D011802:Quinidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D014581:Urticaria / Q000139:chemically induced* / Q000473:pathology; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000139:chemically induced* / Q000473:pathology
D000889:Anti-Arrhythmia Agents; D011802:Quinidine