title: Drug-associated cutaneous vasculitis: study of 239 patients from a single referral center.
abstract: OBJECTIVE
  The 2012 International Chapel Hill Consensus Conference on the Nomenclature of Vasculitides defined drug-associated immune complex vasculitis as a distinct entity included within the category of vasculitis associated with probable etiology. In the present study we assessed the clinical spectrum of patients with drug-associated cutaneous vasculitis (DACV).
  
  
  METHODS
  Case records were reviewed of patients with DACV treated at a tertiary referral hospital over a 36-year period. A diagnosis of DACV was considered if the drug was taken within a week before the onset of the disease.
  
  
  RESULTS
  From a series of 773 unselected cutaneous vasculitis cases, 239 patients (30.9%; 133 men and 106 women; mean age 36 yrs) were diagnosed with DACV. Antibiotics (n=149; 62.3%), mainly β-lactams and nonsteroidal antiinflammatory drugs (NSAID; n=24; 10%) were the most common drugs. Besides skin lesions (100%), the most common clinical features were joint (51%) and gastrointestinal (38.1%) manifestations, nephropathy (34.7%), and fever (23.8%). The most remarkable laboratory data were increased erythrocyte sedimentation rate (40.2%), presence of serum cryoglobulins (26%), leukocytosis (24.7%), positive antinuclear antibodies (21.1%), anemia (18.8%), and positive rheumatoid factor (17.5%). Despite drug discontinuation and bed rest, 108 patients (45.2%) required medical treatment, mainly corticosteroids (n=71) or immunosuppressive drugs (n=7). After a median followup of 5 months, relapses occurred in 18.4% of patients, and persistent microhematuria or renal insufficiency in 3.3% and 5%, respectively.
  
  
  CONCLUSIONS
  DACV is generally associated with antibiotics and NSAID. In most cases it has a favorable prognosis, although a small percentage of patients may develop residual renal damage.
authors.affiliation: From the Divisions of Rheumatology, Internal Medicine, Pathology, and Dermatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.F. Ortiz-Sanjuán, MD; R. Blanco, MD, PhD; T. Pina, MD; V. Calvo-Río, MD; J. Loricera, MD; J. Rueda-Gotor, MD; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, University of Cantabria; J.L. Hernández, MD, PhD, División of Internal Medicine, Hospital Universitario Marqués de Valdecilla, University of Cantabria; M.C. González-Vela, MD, PhD, Division of Pathology, Hospital Universitario Marqués de Valdecilla; H. Fernández-Llaca, MD; S. Armesto, MD, PhD; M.A. González-López, MD, PhD, División of Dermatology, Hospital Universitario Marqués de Valdecilla.
authors.forename: Francisco
authors.initials: F
authors.lastname: Ortiz-Sanjuán
authors.affiliation: From the Divisions of Rheumatology, Internal Medicine, Pathology, and Dermatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.F. Ortiz-Sanjuán, MD; R. Blanco, MD, PhD; T. Pina, MD; V. Calvo-Río, MD; J. Loricera, MD; J. Rueda-Gotor, MD; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, University of Cantabria; J.L. Hernández, MD, PhD, División of Internal Medicine, Hospital Universitario Marqués de Valdecilla, University of Cantabria; M.C. González-Vela, MD, PhD, Division of Pathology, Hospital Universitario Marqués de Valdecilla; H. Fernández-Llaca, MD; S. Armesto, MD, PhD; M.A. González-López, MD, PhD, División of Dermatology, Hospital Universitario Marqués de Valdecilla.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Blanco
authors.affiliation: From the Divisions of Rheumatology, Internal Medicine, Pathology, and Dermatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.F. Ortiz-Sanjuán, MD; R. Blanco, MD, PhD; T. Pina, MD; V. Calvo-Río, MD; J. Loricera, MD; J. Rueda-Gotor, MD; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, University of Cantabria; J.L. Hernández, MD, PhD, División of Internal Medicine, Hospital Universitario Marqués de Valdecilla, University of Cantabria; M.C. González-Vela, MD, PhD, Division of Pathology, Hospital Universitario Marqués de Valdecilla; H. Fernández-Llaca, MD; S. Armesto, MD, PhD; M.A. González-López, MD, PhD, División of Dermatology, Hospital Universitario Marqués de Valdecilla.
authors.forename: José L
authors.initials: JL
authors.lastname: Hernández
authors.affiliation: From the Divisions of Rheumatology, Internal Medicine, Pathology, and Dermatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.F. Ortiz-Sanjuán, MD; R. Blanco, MD, PhD; T. Pina, MD; V. Calvo-Río, MD; J. Loricera, MD; J. Rueda-Gotor, MD; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, University of Cantabria; J.L. Hernández, MD, PhD, División of Internal Medicine, Hospital Universitario Marqués de Valdecilla, University of Cantabria; M.C. González-Vela, MD, PhD, Division of Pathology, Hospital Universitario Marqués de Valdecilla; H. Fernández-Llaca, MD; S. Armesto, MD, PhD; M.A. González-López, MD, PhD, División of Dermatology, Hospital Universitario Marqués de Valdecilla.
authors.forename: Trinitario
authors.initials: T
authors.lastname: Pina
authors.affiliation: From the Divisions of Rheumatology, Internal Medicine, Pathology, and Dermatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.F. Ortiz-Sanjuán, MD; R. Blanco, MD, PhD; T. Pina, MD; V. Calvo-Río, MD; J. Loricera, MD; J. Rueda-Gotor, MD; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, University of Cantabria; J.L. Hernández, MD, PhD, División of Internal Medicine, Hospital Universitario Marqués de Valdecilla, University of Cantabria; M.C. González-Vela, MD, PhD, Division of Pathology, Hospital Universitario Marqués de Valdecilla; H. Fernández-Llaca, MD; S. Armesto, MD, PhD; M.A. González-López, MD, PhD, División of Dermatology, Hospital Universitario Marqués de Valdecilla.
authors.forename: María C
authors.initials: MC
authors.lastname: González-Vela
authors.affiliation: From the Divisions of Rheumatology, Internal Medicine, Pathology, and Dermatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.F. Ortiz-Sanjuán, MD; R. Blanco, MD, PhD; T. Pina, MD; V. Calvo-Río, MD; J. Loricera, MD; J. Rueda-Gotor, MD; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, University of Cantabria; J.L. Hernández, MD, PhD, División of Internal Medicine, Hospital Universitario Marqués de Valdecilla, University of Cantabria; M.C. González-Vela, MD, PhD, Division of Pathology, Hospital Universitario Marqués de Valdecilla; H. Fernández-Llaca, MD; S. Armesto, MD, PhD; M.A. González-López, MD, PhD, División of Dermatology, Hospital Universitario Marqués de Valdecilla.
authors.forename: Héctor
authors.initials: H
authors.lastname: Fernández-Llaca
authors.affiliation: From the Divisions of Rheumatology, Internal Medicine, Pathology, and Dermatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.F. Ortiz-Sanjuán, MD; R. Blanco, MD, PhD; T. Pina, MD; V. Calvo-Río, MD; J. Loricera, MD; J. Rueda-Gotor, MD; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, University of Cantabria; J.L. Hernández, MD, PhD, División of Internal Medicine, Hospital Universitario Marqués de Valdecilla, University of Cantabria; M.C. González-Vela, MD, PhD, Division of Pathology, Hospital Universitario Marqués de Valdecilla; H. Fernández-Llaca, MD; S. Armesto, MD, PhD; M.A. González-López, MD, PhD, División of Dermatology, Hospital Universitario Marqués de Valdecilla.
authors.forename: Vanesa
authors.initials: V
authors.lastname: Calvo-Río
authors.affiliation: From the Divisions of Rheumatology, Internal Medicine, Pathology, and Dermatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.F. Ortiz-Sanjuán, MD; R. Blanco, MD, PhD; T. Pina, MD; V. Calvo-Río, MD; J. Loricera, MD; J. Rueda-Gotor, MD; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, University of Cantabria; J.L. Hernández, MD, PhD, División of Internal Medicine, Hospital Universitario Marqués de Valdecilla, University of Cantabria; M.C. González-Vela, MD, PhD, Division of Pathology, Hospital Universitario Marqués de Valdecilla; H. Fernández-Llaca, MD; S. Armesto, MD, PhD; M.A. González-López, MD, PhD, División of Dermatology, Hospital Universitario Marqués de Valdecilla.
authors.forename: Javier
authors.initials: J
authors.lastname: Loricera
authors.affiliation: From the Divisions of Rheumatology, Internal Medicine, Pathology, and Dermatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.F. Ortiz-Sanjuán, MD; R. Blanco, MD, PhD; T. Pina, MD; V. Calvo-Río, MD; J. Loricera, MD; J. Rueda-Gotor, MD; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, University of Cantabria; J.L. Hernández, MD, PhD, División of Internal Medicine, Hospital Universitario Marqués de Valdecilla, University of Cantabria; M.C. González-Vela, MD, PhD, Division of Pathology, Hospital Universitario Marqués de Valdecilla; H. Fernández-Llaca, MD; S. Armesto, MD, PhD; M.A. González-López, MD, PhD, División of Dermatology, Hospital Universitario Marqués de Valdecilla.
authors.forename: Susana
authors.initials: S
authors.lastname: Armesto
authors.affiliation: From the Divisions of Rheumatology, Internal Medicine, Pathology, and Dermatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.F. Ortiz-Sanjuán, MD; R. Blanco, MD, PhD; T. Pina, MD; V. Calvo-Río, MD; J. Loricera, MD; J. Rueda-Gotor, MD; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, University of Cantabria; J.L. Hernández, MD, PhD, División of Internal Medicine, Hospital Universitario Marqués de Valdecilla, University of Cantabria; M.C. González-Vela, MD, PhD, Division of Pathology, Hospital Universitario Marqués de Valdecilla; H. Fernández-Llaca, MD; S. Armesto, MD, PhD; M.A. González-López, MD, PhD, División of Dermatology, Hospital Universitario Marqués de Valdecilla.
authors.forename: Marcos A
authors.initials: MA
authors.lastname: González-López
authors.affiliation: From the Divisions of Rheumatology, Internal Medicine, Pathology, and Dermatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.F. Ortiz-Sanjuán, MD; R. Blanco, MD, PhD; T. Pina, MD; V. Calvo-Río, MD; J. Loricera, MD; J. Rueda-Gotor, MD; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, University of Cantabria; J.L. Hernández, MD, PhD, División of Internal Medicine, Hospital Universitario Marqués de Valdecilla, University of Cantabria; M.C. González-Vela, MD, PhD, Division of Pathology, Hospital Universitario Marqués de Valdecilla; H. Fernández-Llaca, MD; S. Armesto, MD, PhD; M.A. González-López, MD, PhD, División of Dermatology, Hospital Universitario Marqués de Valdecilla.
authors.forename: Javier
authors.initials: J
authors.lastname: Rueda-Gotor
authors.affiliation: From the Divisions of Rheumatology, Internal Medicine, Pathology, and Dermatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.F. Ortiz-Sanjuán, MD; R. Blanco, MD, PhD; T. Pina, MD; V. Calvo-Río, MD; J. Loricera, MD; J. Rueda-Gotor, MD; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, University of Cantabria; J.L. Hernández, MD, PhD, División of Internal Medicine, Hospital Universitario Marqués de Valdecilla, University of Cantabria; M.C. González-Vela, MD, PhD, Division of Pathology, Hospital Universitario Marqués de Valdecilla; H. Fernández-Llaca, MD; S. Armesto, MD, PhD; M.A. González-López, MD, PhD, División of Dermatology, Hospital Universitario Marqués de Valdecilla. miguelaggay@hotmail.com.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: González-Gay
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D001707:Biopsy, Needle; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012017:Referral and Consultation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D062606:Tertiary Care Centers; D014657:Vasculitis / Q000139:chemically induced* / Q000453:epidemiology* / Q000473:pathology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: CUTANEOUS VASCULITIS; DRUG-ASSOCIATED VASCULITIS; DRUGS; HYPERSENSITIVITY VASCULITIS; PALPABLE PURPURA