Henoch-Schönlein purpura associated with clarithromycin. Case report and review of literature.
OBJECTIVE
To report a case of Henoch-Schönlein purpura that appears to be related to the intake of clarithromycin for pharyngitis/tonsillitis.


METHODS
We describe a case of Henoch-Schönlein associated with clarithromycin therapy in a 48-year-old white man with no history of allergic drug reactions. Four days after starting therapy, he came to our hospital emergency room because of a non-pruritic palpable purpuric rash on the trunk and extremities and arthralgias involving elbows and knees. Administration of clarithromycin was suspended, in a few days, arthralgias and skin lesions quickly resolved. Three weeks later, the patient presented again with abdominal pain, dark-red urine and swelling of the legs. Urinalysis revealed proteinuria of 11 g/24 h and hematuria. A percutaneous renal biopsy showed a diffuse endocapillary proliferative glomerulonephritis with segmental areas of fibrinoid necrosis within glomeruli, on immunofluorescence study granular deposits of IgA and C3 were present in the mesangium and capillary walls. A diagnosis of HSP was made. We suspected that the causative agent might be clarithromycin since this was the only drug added before the cutaneous and renal condition appeared.


CONCLUSIONS
Our case and the previous case suggest that HSP may represent a potential adverse effect of clarithromycin, clinicians should be alerted to this potentially severe side effect of such a widely used drug. In accordance with the data obtained and based on the Naranjo algorithm, the adverse reaction could be considered possible.
Borrás-Blasco
J
J
Pharmacy Service, Hospital General Universitario de Elche, Elche, Alicante, Spain. jborrasb@sefh.es
Enriquez
R
R
Amoros
F
F
Cabezuelo
J B
JB
Navarro-Ruiz
A
A
Pérez
M
M
Fernández
J
J
D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D017291:Clarithromycin / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D011695:IgA Vasculitis / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D010612:Pharyngitis / Q000150:complications / Q000188:drug therapy; D014069:Tonsillitis / Q000150:complications / Q000188:drug therapy
D000900:Anti-Bacterial Agents; D017291:Clarithromycin